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CDEHRIGHT DEPOSm 



ROBINSON'S PRESCRIPTION INCOMPATIBILITIES 

A TREATISE ON 

PRESCRIPTION 
INCOMPATIBILITIES 

AND DIFFICULTIES 

INCLUDING PRESCRIPTION ODDITIES AND CURIOSITIES 

FOR PHARMACISTS AND PHYSICIANS AND STUDENTS 
IN PHARMACY AND MEDICINE 

BY 

WILLIAM J. ROBINSON, Ph.G., M.D. 

EDITOR OF THE CRITIC AND GUIDE AND THE AMERICAN JOURNAL 
OF UROLOGY AND SEXOLOGY 

Formerly President New York Board of Pharmacy Institute; Fellow New York Academy 
of Medicine, American Medical Association, member New York State and 
County Medical Society, American Association for the Advance- 
ment of Science, etc., etc. 
Author: Organic Materia Medica, Posology and Toxicology; Elementary Course in 
Chemistry; Elementary Course in Pharmacy; A Complete Quiz System of 
Pharmacy; Practical Druggist Institute Course of Pharmacy; 
A Practical Course in Pharmacy, Chemistry, Materia 
Medina and Toxicology. 
Author: Sex Knowledge for Men; Woman: Her Sex and Love Life; Treatment of Sexual 
Impotence and Other Sexual Disorders in Men and U omen; Treatment of 
Gonorrhea; Sexual Problems of Today; Birth Control or The Lim- 
itation of Offspring by the Prevention of Conception; 
Never Told Tales; Eugenics and Marriage, 
etc., etc. 



1919 
CRITIC AND GUIDE COMPANY 

12 MT. MORRIS PARK WEST 

NEW YORK 



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Copyright, 1919, 
By The Critic and Guide Co. 



AUG 18 1919 



©CI.A529600 










TO THE MEMORY 
OF 

CHARLES RICE 

One of the Noblest Representatives op 
Professional Pharmacy 

IN THIS COUNTRY 

A Modest and Unselfish Man of Science 

i gratefully and reverently 

dedicate this volume 

W. J. R. 



PREFACE 

FRANKNESS demands the statement that the subject of 
Prescription Incompatibilities is of considerably less 
importance now than it was twenty or thirty years 
ago. It was a rare day then when an editor of a pharma- 
ceutical journal or one who was considered an expert in 
solving incompatible riddles did not receive orally or in writ- 
ing a despairing call for help from some sorely puzzled drug- 
gist, who in attempting to put up a prescription as written 
by the doctor, got an unsightly, impossible mass, a strange, 
unlooked-for color, or perhaps a dangerously explosive mix- 
ture. And pharmaceutical journals devoted a good deal more 
space than they do now answering the "incompatible" 
queries of their subscribers. The flood of new remedies and 
synthetics was then at its height and the physician still un- 
weaned from his habit of polypharmacal prescribing insisted 
on joining together things which the spirits of chemistry, 
pharmacy and therapeutics intended should be kept asunder. 
The idea at that time was still pretty general that the value 
of a prescription increased in direct ratio to the number of 
its ingredients. And the result was — not infrequently — a 
spoiled, useless, ludicrous, or even dangerous combination. 
Things are different now. Our propaganda during the 
past twenty-five years in favor of simple rational prescriptions 
has borne fruit. The modern physician does not believe in 
shotgun prescriptions; he prescribes one, seldom more than 
two or three active ingredients in a prescription. In fact, 
the tendency is now towards the other extreme : single reme- 
dies is the slogan, the physician thus not infrequently de- 
priving himself of valuable synergistic or corrective combi- 

5 



6 PREFACE 

nations. Of course, the fewer the ingredients in a prescrip- 
tion, the fewer the chances for incompatible combinations or 
impossible absurdities. 

Nevertheless, the days of incompatible prescriptions and 
questionable combinations are not entirely over. Not as 
often as formerly, but still often enough is the author ap- 
pealed to to clear up difficult points in physicians' prescrip- 
tions, and it is lack of time, and not lack of opportunity, 
that prevents him from playing the role of oracle on in- 
compatibilities to the pharmaceutical profession. No, the 
subject of incompatibilities has not yet altogether lost its 
importance. And every intelligent pharmacist as well as 
every self-respecting and conscientious physician should be 
on terms of familiarity with the salient facts of prescription 
writing,, so that the latter may avoid and the former correct 
glaring absurdities. 

It is just a quarter of a century since the author began 
to teach and to write on the subject of this book. His first 
Treatise on Prescription Incompatibilities and Difficulties 
appeared in Merck's Report, where it ran for several years. 
In a revised form it was published in The Critic and Guide 
for 1903, 1904 and 1905. It is not a mere phrase to state 
that the Treatise met with exceptional favor. It was claimed 
that the author was the only writer in the field who suc- 
ceeded in making a dreary and dry-as-dust subject readable 
and interesting. And being interesting, the subject became 
memorizable ; it left an impression on the tablets of one's 
memory, which a dreary, non-interesting subject rarely does. 
The requests to reprint the Treatise in a separate volume 
were quite numerous — but then a busy practice and other, 
more interesting literary work made compliance with the re- 
quest a practical impossibility. And with each year that 
passed the Treatise became more inadequate — because new 
remedies came into use and with them new incompatibili- 
ties, and the composition of certain pharmacopeial galenicals 
became changed, so that explanations and criticisms which 



PREFACE 7 

held good before, held good no longer. To bring the Treatise 
on Prescription Incompatibilities up to date required con- 
siderable additions, a few eliminations and a thorough re- 
vision. I despaired of ever having the time to devote to it. 

But I recently achieved some leisure and I have taken the 
opportunity to subject the Treatise to a thorough revision 
and to bring it up to date. And I now take pleasure in pre- 
senting this enlarged and revised Treatise on Prescription 
Incompatibilities and Difficulties, including Prescription 
Oddities and Curiosities, to my friends in the pharmaceutical 
and medical professions. 

A word on the kind of prescriptions and incompatibilities 
that are discussed in this Treatise. They are bona fide pre- 
scriptions and combinations, and the incompatibilities are 
such as have presented themselves to some druggists and 
physicians and are apt to present themselves again to others. 
It is not only superfluous and unnecessarily space-consum- 
ing, but it is mind-confusing and discouraging to present 
incompatibilities in prescriptions which never happened and 
never could happen, because no physician in his wildest flights 
of fancy would ever think of writing such combinations. 

Let me illustrate by some examples: Of what use is it 
to tell a physician or a pharmacist, or a medical or pharma- 
ceutical student, that mucilage of acacia is precipitated by 
sodium phosphomolybdate, that acetanilid gives a white pre- 
cipitate with bromine, that meconic acid gives a precipitate 
with barium chloride, that urethane give off some ammonia 
when heated with a solution of potassium or sodium hy- 
droxide, that cadmium salts are precipitated by alkali car- 
bonates and chromates, that gamboge with ammonia water 
gives a yellow colored solution, that a mixture of cocaine 
and calomel acquires a dark color if the fumes of hydro- 
chloric acid are blown over it, that a solution of methyl- 
thionine hydrochloride is precipitated by potassium bichro- 
mate, that piperazine explodes when heated to a certain tem- 
perature with sodium hypochlorite, that potassium salts give 



8 PREFACE 

a yellow precipitate with platinic chloride and hydrochloric 
acid, that sugar is decomposed with ignition by concentrated 
sulphuric acid, that thymol is incompatible with chromic 
acid, etc., etc. — the list could be extended indefinitely. 

It is not merely superfluous, but, as stated above, is confus- 
ing and discouraging to the student. For, seeing that most 
drugs have dozens and some even hundreds of incompati- 
bilities, he loses courage and despairs of ever mastering the 
subject. Why, many of the chemicals given as incompatibles 
of this, that and the other thing are not even medicinal 
preparations, are never used in medicine, are never prescribed 
and consequently can never form the subject of prescription 
incompatibilities! Who ever heard of a doctor prescribing 
acacia with sodium phosphomolybdate, acetanilid with bro- 
mine (elementary bromine!) ? And of what interest is it to 
a student of incompatibilities to know that meconic acid 
is incompatible with barium chloride ? Have the two ever been 
prescribed? And has a doctor ever prescribed sugar with 
concentrated sulphuric acid? Or has anybody ever ordered 
to blow the fumes of HC1 over a mixture of cocaine and 
calomel? And so on. So what is it all for? The examples 
I have enumerated are chemical tests and reactions — they are 
useful in their place, but they have nothing to do with the 
subject of incompatibilities. This book will be found free 
from the superfluities referred to, and will, it is hoped, be 
found more acceptable and more useful on that account. 

W. J. R. 

12 Mount Morris Park West 



INTRODUCTION 

THE subject of incompatibilities has always been the 
bete noire of the pharmacist and physician. Whether 
it is because the subject is really a difficult one, or 
because it has not received proper and satisfactory treat- 
ment in our text-books, in our pharmaceutical and medical 
journals, or because the educational standard of the pharma- 
cist and physician is not high enough, not broad enough to 
enable them to master the subject thoroughly, certain it is 
that the number of pharmacists and physicians who are able 
to grapple successfully with all the intricacies of prescrip- 
tion incompatibilities is a very limited one. It shall be the 
purpose of this treatise to solve the many mysteries of incom- 
patibilities. It is the author 's conviction, based upon an expe- 
rience of many years, that there is no subject, no matter how 
apparently intricate and complicated, that cannot be mas- 
tered by a person of average intelligence, provided it be 
presented in the proper light and in a proper manner; that 
there is no subject, no matter how dry, that cannot be made 
interesting and attractive. 

The author's opportunities for seeing and analyzing incom- 
patible prescriptions have always been exceptionally favor- 
able ones. Besides the large collections he has made in his 
quondam drug-store practice, he is constantly receiving in- 
quiries from pharmacists in various parts of the city and 
country, regarding some mooted points. He is also fre- 
quently honored with letters from physicians, who, on getting 
untoward effects from some combinations, ask for enlighten- 
ment. They frequently inquire whether it is the fault of 
the combinations, or whether the druggist had perhaps sub- 



10 PRESCRIPTION INCOMPATIBILITIES 

stituted something else for what had been prescribed. 
Finally, the author had been for a number of years regular 
"consultant" to a number of pharmaceutical journals and 
in this capacity he has had to analyze and explain incom- 
patible prescriptions almost daily. 

As to why I consider the subject of prescription incompati- 
bilities of such paramount importance to the pharmacist, I 
can do no better than to quote from a paper of mine on the 
subject, read at the Twenty-second Annual Convention of 
the New York State Pharmaceutical Association. I started 
that paper by stating that the business of the retail pharma- 
cist of the present day consisted of three branches: that of 
manufacturing galenical preparations, that of selling patent 
medicines, druggists' sundries, etc., and that of dispensing 
physicians ' prescriptions. 

The first two departments have been encroached upon to 
a very great extent. The large manufacturing houses with 
limitless facilities, improved machinery, immense capital and 
modern methods have been able to offer certain classes of 
preparations to the retail druggist at such a price as to take 
away from him every incentive to do his own manufactur- 
ing. And there is no help for that. No matter how we may 
deplore the fact that the druggist of the present day is 
unable to spread a plaster or roll a pill so dexterously as did 
the apothecary of a generation or two ago, you cannot change 
the tendency of the times. For the sake of sentiment no 
druggist will spend several hours in making a preparation, 
which he can purchase ready made and as well made at a 
lower price. 

The sale of patent medicines, etc., is being every day more 
and more monopolized by the department stores. This is 
also inevitable, as will be admitted by any one who has 
given the subject some thought and who can read the signs 
of the times. 

But there is one department which is still the pharmacist's 
own — a department which distinguishes him as a profes- 



PRESCRIPTION INCOMPATIBILITIES 11 

sional man and elevates him above the ordinary merchant. 
I refer to the prescription department. That is a depart- 
ment which nobody can take away from the pharmacist; be- 
cause, while no law can be passed to prevent people from 
selling ordinary drugs and patent medicines, the dispensing 
of prescriptions can be limited to qualified pharmacists only. 
And to the development of this department the pharmacist 
should devote his best energies. To do this successfully he 
must become a master prescriptionist and be familiar with 
all the intricacies of prescription incompatibilities. Nothing 
will more securely hold your physician's patronage than his 
confidence in your ability as a prescriptionist, in your abil- 
ity to dispose of difficulties and to prevent untoward results. 

It has always been a source of wonder to me why the sub- 
ject of incompatibilities has been so sadly neglected in our 
college curricula. The student is taught the various steps 
of preparing sulphuric acid, or of the preparation of soda by 
the Leblanc process (things of which he will never make any 
practical application), but he is left in ignorance as to how 
to mix Fowler's solution and Magendie's solution without 
precipitation. He is taught the difference between cast and 
wrought iron, but he is left in ignorance as to why a pre- 
cipitate occurs on the addition of potassium iodide to syrup 
of ferrous iodide and how to prevent it. 

To me the subject of prescription incompatibilities has 
always seemed of paramount importance. It is practically 
more useful than botany, more useful than pharmacognosy, 
and even more useful than manufacturing chemistry — and I 
hope the time is not far distant when it will occupy the first 
rank in the curriculum of every school of pharmacy in the 
United States. 



The word c ' incompatible, ' ' according to the definition of 
the various dictionaries, means incapable of existing together 
in agreement or harmony. We call a prescription incompati- 



12 PRESCRIPTION INCOMPATIBILITIES 

ble when its ingredients are of such a nature that, if brought 
together, one or more of the following changes would take 
place: (1) Mutual decomposition of the ingredients, with 
the formation of a new compound; (2) precipitation, chemical 
or physical; (3) explosion; (4) deflagration; (5) liquefac- 
tion, when the ingredients are prescribed in powders; (6) the 
deterioration or destruction of one or more of the ingredients. 

But it would be a mistake to suppose that the word incom- 
patible is synonymous with "non-dispensable." On the con- 
trary, as will be seen later, there are many combinations 
which, broadly speaking, are incompatible, but not only may 
they be dispensed without any hesitation, the incompatibility 
is intentional and distinctly desirable. 

Incompatibilities are generally divided into three classes: 
(1) Chemical incompatibility, where the change is the result 
of a true chemical reaction, e. g., when sodium salicylate is 
prescribed with diluted sulphuric acid, salicylic acid precipi- 
tates out, and sodium sulphate is in solution; (2) pharma- 
ceutical, when the change is the result of a physical condi- 
tion, i. e., when the menstruum is unsuitable, e. g., when 
fluid extract of cannabis indica is added to water and the 
resin is thrown out of solution; and (3) therapeutic, where 
the drugs prescribed have antagonistic medicinal properties 
(as when chloral and strychnine are prescribed together, or 
digitalis and aconite). With the latter variety, therapeutic 
incompatibility, the pharmacist has absolutely nothing to do, 
nor is he to permit himself to make any suggestions to the 
physician in that direction. The pharmacist is not compe- 
tent to judge of what constitutes therapeutic incompatibility ; 
it is none of his affair ; two drugs may be antagonistic in one 
respect and synergistic in another, and it is for the latter 
effect that the physician prescribes them. 

The author's classification of incompatibilities, which he 
introduced several years ago and which has been found both 
useful and practical, is as follows: 

(1) Permissible and desirable incompatibility, when the 



PRESCRIPTION INCOMPATIBILITIES 13 

resulting change is of no significance, or where the new com- 
pound is expressly desired by the physician. 

(2) Preventable incompatibility, where the incompatibil- 
ity can easily be prevented, either by a change in the order 
of mixing the ingredients, or by the addition of acid, etc., and 

(3) Absolute, or true, incompatibility, where the prescrip- 
tion cannot possibly be dispensed in its original form and 
where one or more ingredients must be left out altogether 
or other ingredients substituted. It is this last kind of in- 
compatibility which is practically synonymous with non- 
dispensability. This classification I have found especially 
useful for students. 



PRESCRIPTIONS 

TO master the subject of incompatibilities, each prescrip- 
tion should be read carefully. It is not necessary to 
attempt to memorize all incompatibilities ; but it is im- 
portant to try to understand the general principles. At the 
end of the volume, the incompatibilities will be summarized 
and classified alphabetically, so that they can be easily re- 
ferred to. 

1. Morphinae Sulphatis gr. iv 

Ac. Tannici gr. viii 

Aquae Destillatae % ij 

Inject with ear syringe. 
I start this series of incompatible, difficult and odd prescrip- 
tions with the above, because it is so very common. With all 
that has been written on prescription incompatibilities one 
would think that such a combination would not present any 
difficulty to any pharmacist. But such, it appears, is not 
the case. The druggist seemed to be very much surprised 
and indignant at the fact that a "precipitate formed when 
he added the tannic acid to the solution of morphine, which 
did not dissolve on long shaking." Well, a precipitate does 
form when tannic acid is added to morphine, and not only 
to morphine, but to all other alkaloids. This is one of the 
commonest kind of incompatibility that we encounter in the 
drug store practice. 

Alkaloids Are Incompatible with Tannic Acid or with 
Substances Containing Tannin. 

The alkaloid is precipitated out of its solution as a tan- 
nate. 

In the above prescription we see a good example of true 

15 



16 PRESCRIPTION INCOMPATIBILITIES 

incompatibility. The physician apparently prescribed the 
tannic acid as an astringent to stop a discharge in the ear; 
the canal of the ear being painful, he also prescribed mor- 
phine sulphate with the intention of diminishing the pain, 
but this latter object is completely defeated, because the 
morphine sulphate is converted into the insoluble morphine 
tannate, which being insoluble cannot be absorbed and can- 
not act. Even the astringent action of the tannic acid is 
diminished, because a part of the latter is precipitated and 
is in combination with the morphine. 

2. Morphinae Sulphatis gr. iv 

Ammonii Carbonatis 5 jss 

Syr. Senegae 5 ss 

Aquae q.s. ad J iij 

S. Teaspoonful 4 times a day, as directed. 

A very common prescription, but incompatible neverthe- 
less. The morphine is precipitated in the alkaloidal form 
by the ammonium carbonate which is a strong alkali. Of 
course putting a shake label on the bottle diminishes the 
danger to a great extent, but it does not entirely eliminate 
it. As a general rule mixtures with poisonous precipitates 
or sediments should not be dispensed. 

In the above prescription, the syrup of senega alone would 
have a tendency to precipitate the morphine because it con- 
tains some water of ammonia. 

Alkaloids Are Precipitated by, and Therefore Incompat- 
ible with, Alkaline Hydroxides, Their Carbonates and Bi- 
carbonates and with salts having an alkaline reaction. 

Such are : potassium hydroxide, carbonate and bicarbonate ; 
sodium hydroxide, carbonate and bicarbonate; ammonium 
hydroxide (= ammonia water) and carbonate; calcium 
hydroxide (= lime water) ; sodium borate and sodium phos- 
phate, the latter salts having an alkaline reaction. Magnesium 
hydroxide, Mg(OH) 2 , has the same tendency, but its solu- 
bility is very slight and it is seldom prescribed in combina- 
tion with alkaloids. 



PRESCRIPTION INCOMPATIBILITIES 17 

3. Morphinae Sulphatis gr. i j 

Antimon. et Potass. Tartratis gr. ij 

Ammon. Chloridi 3 j 

Syr. Pruni Virgin J ij 

Tannic acid is an excellent precipitant of tartar emetic (the 
precipitate formed is antimony tannate), and wild cherry 
contains a large amount of tannic acid. The morphine will 
also be precipitated, as morphine tannate. It is true that 
no reports of bad results have ever reached me — probably 
because the precipitates are so well suspended in the thick 
syrup. Nevertheless, the combination is not a good one. If 
it is dispensed, a "shake" label should invariably accom- 
pany it. 

Tannic Acid Precipitates and Is Therefore Incompati- 
ble with Tartar Emetic (Antimony and Potassium Tar- 
trate). 

4. Fluidextr. Cannabis Indie 3 ij 

Kali Bromati 3 vj 

Aquae Menthae Pip 3 iij 

The resins contained in the cannabis indica precipitate 
when added to water. The finely divided precipitate grad- 
ually collects in little lumps. A nice homogeneous mixture 
can be made by rubbing the fluidextract with one or two 
drams of acacia, and then gradually adding some water so 
as to form an emulsion. The mixture will also have a much 
less disagreeable taste; so that both from a pharmaceutical 
and a gustatory point of view the employment of acacia is 
not only justifiable, but clearly indicated. This is a typical 
example of pharmaceutical incompatibility. 

Resinous Fluidextracts and Tinctures Precipitate 
When Mixed with Water. 

5. Hydrogenii Peroxidi 

Aquae Calcis aa 60.0 

S. Use for throat in atomizer. 
On mixing the two solutions a whitish precipitate is n6- 



18 PRESCRIPTION INCOMPATIBILITIES 

ticed. This precipitate is generally considered to consist of 
calcium sulphate or calcium phosphate, the formation of those 
precipitates being due to the sulphuric or phosphoric acid 
contained, in small amounts, in the peroxide of hydrogen. 
This explanation is true as far as it goes, but it does not 
go far enough. The precipitate also occurs in varieties of 
peroxide of hydrogen which contain no sulphuric or phos- 
phoric acid, but only hydrochloric acid. It certainly cannot 
be due to the latter, because calcium chloride is a very solu- 
ble salt. No, the chief precipitate is due to the formation 
of calcium peroxide, which is a white crystalline compound. 
The equation is a simple one : 

Ca(OH) 2 + BW)i = CaO. + 2H»0. 

The question under discussion is not one of theoretical 
interest only ; it is of great practical importance. If the pre- 
cipitation were due to the formation of calcium sulphate or 
phosphate only, no objections could be raised to the prescrip- 
tion. In fact, except for the precipitate clogging the holes 
in the atomizer, the addition of lime water to peroxide of 
hydrogen might be considered an advantage, because the acid- 
ity of the latter becomes neutralized and the sharp burning 
taste is lost. But having learned that the peroxide becomes 
decomposed, we see that the combination is an inadmissible 
one. 

It Is Best Not to Prescribe Lime Water and Peroxide 
of Hydrogen in the Same Mixture. 

I might add that calcium peroxide is a commercial prod- 
uct, being sold under various names as a gastrointestinal anti- 
septic. 

6. Protargol gr. ij 

Zinci Sulphatis gr. iij 

Aquae Destillatae 3 iv 

M.f. Collyrium. 
This prescription is absolutely incompatible. On adding 
the zinc sulphate to the protargol solution the latter becomes 



PRESCRIPTION INCOMPATIBILITIES 19 

completely decolorized, while at the same time a rather abun- 
dant precipitate takes place. (The precipitate is soluble in 
ammonia water.) To dispense it with the precipitate is of 
course inadmissible, the prescription being intended for an 
eye wash, or eye drops. The druggist who received this pre- 
scription, dispensed it after filtering out the precipitate. A 
very poor way. It is much better to leave out the sulphate 
of zinc and notify the physician. 

Protargol Is Absolutely Incompatible with Zinc Sul- 
phate. 

7. Tr. Ferri Chloridi I ss 

Syr. Simplicis 5 j 

Aquae Cinnamomi q.s. ad 3 iv 

It does not seem as if anything could be the matter with 
this innocent prescription, but there is. The cinnamic alde- 
hyde present in the oil of cinnamon (from which the water is 
prepared) reacts with the ferric chloride; the solution, at first 
clear, becomes after a short time turbid and dirty-looking, 
and a slight deposit forms. It is best to substitute another 
water for the cinnamon water, with the physician's knowl- 
edge, of course, but if the prescription must be dispensed as 
written, the patient should invariably be informed of the 
change in the appearance which the medicine will undergo 
in a few hours. Otherwise he will be almost sure to bring 
it back the next day, with the question if a mistake had 
not been made, or if the medicine did not get spoiled. If the 
patient is prepared for such a thing he will never make any 
fuss about it; on the contrary, his respect for the druggist's 
knowledge and predicting powers will be greatly increased. 

8. Tr. Ferri Chloridi 5 i j 

Spir. Pimentae 3 j 

Syrupi Sacchari 3 j 

Aquae q.s. ad 3 iij 

The Eugenol present in the oil of pimenta reacts with the 
ferric chloride, producing a turbidity in the mixture, with the 



20 PRESCRIPTION INCOMPATIBILITIES 

final deposition of a dark-brown precipitate. The same reac- 
tion takes place if Aqua Pimentae is used instead of the 
spirit. The remarks concerning the preceding prescription 
apply also to this one. 

9. Acidi Tannici 3 j 

Aquae Calcis § iv 

S. Use as a gargle. 

Tannic acid is incompatible with lime water. When the 
two are mixed, a bulky, bluish-white precipitate results. The 
precipitate is a tannate of calcium, though its composition 
is somewhat variable. The prescription should hardly be 
dispensed. 

Lime Water and Other Soluble Calcium Salts Are In- 
compatible with Tannic Acid. 

10. Glyceriti Ac Tannici 3 ij 

Aquae Calcis : 3 vj 

S. Use as a gargle. 
The same reaction takes place here, only the precipitate is 
of a whitish color and is, on account of the glycerin, more 
evenly distributed. This prescription may be dispensed, but 
it is best, perhaps, to call the physician's attention to the 
incompatibility. 

11. Atrop. Sulphatis gr. v 

Ext. Colchici Sem. Fl 3 ij 

Potassii Iodidi . * gr. x 

Sodii Salicyl gr. xx 

Tr. Guaiaci 3 ss 

Aquae Foeniculi q.s. ad J ij 

S. 3 i every four hours. 

I present this prescription not so much for its incompatible 
points as for its peculiar dosage. When the doctor was told 
that the dose of atropine — % of a grain — was a lethal one, 
he answered irascibly that he did not wish to be bothered in 
the future ; that we knew he was not well up in doses, and 
that therefore we could fix the doses to suit ourselves! He 



PRESCRIPTION INCOMPATIBILITIES 21 

afterwards gave us carte blanche so far as his prescriptions 
were concerned ; we could change the dosage, leave out ingre- 
dients (incompatible ones), etc. Very often he only wrote 
the ingredients, leaving it to us to fix the quantities. He has 
a very large practice, nevertheless ! 

The incompatibilities are: the KI with the atropine (and 
perhaps with the colchicine), and the tincture of guaiac with 
the water (the resin precipitates at once). The tincture 
sometimes strikes a blue color with acacia, but the latter may 
be used to make an emulsion, in spite of this. 

12. Argenti Nitrici gr. xv 

Aquae Destillat ^ i 

Detur in vitro nigro et signa: Pro usu externo. 

This is a perfectly innocent and compatible prescription, 
but the making up of it afforded a good deal of amusement ; 
the senior, the junior, and even the boy joined in the result- 
ing merriment. The incident related here took place in the 
old land-mark pharmacy, at the corner of Houston and Clin- 
ton streets, this city, H. L. Metz and then Nicholas Tauszig, 
proprietors. It was on a Sunday, the boss was out, and busi- 
ness was exceedingly rushing. One hundred and fifty to two 
hundred prescriptions a day was the general average, but that 
day the number was much greater. There were besides quite 
a few "hard" prescriptions, such as 500 silver-coated creo- 
sote pills, 120 suppositories, 500 cachets, etc. A sign was 
therefore put out: "Relief clerk wanted." Soon a young 
man presented himself, who said he had worked in a drug- 
store on the other side, but could find no position here and 
would be glad to relieve for $2.00 an afternoon. The first 
two prescriptions he made up all right. The third prescrip- 
tion was the above. He went to the poison closet, where we 
used to keep all potent drugs, found the bottle with the 
label Argentum nitricum, weighed out the alleged silver ni- 
trate, put it in a bottle, added the water, and started shaking 
it; after shaking violently for two or three minutes, finding 



22 PRESCRIPTION INCOMPATIBILITIES 

that the "silver nitrate" would not dissolve, he emptied the 
contents into a mortar, and started to pound the "silver 
nitrate." This, of course, caused surprise to his fellow-pre- 
scriptionists, and on looking into the mortar it was found 
that the alleged silver nitrate was — flaxseed! As you perhaps 
know, fused silver nitrate formerly used to come in bottles 
filled with flaxseed. This was done to prevent the sticks from 
breaking. He was unfamiliar with the fact and thought, so 
he said, that the flaxseed was a special form in which silver 
nitrate came in this country. But we suspected that he had 
never handled silver nitrate before. 

13. Magnes. CalcirL 3 ii j 

Pulv. Rhei 3 ij 

Pulv. Zingiberis 3 j 

Sodii Bicarbon 3 j 

Olei Menthae Pip gtt. v 

Aquae ad J iv 

After standing for a while this mixture thickens and solidi- 
fies to such an extent that it is impossible to either shake it 
or pour it from the bottle. The cause of it is to be found 
exclusively in the tendency of magnesium oxide to combine 
with water, forming a gelatinous hydrate : MgO + H 2 =a 
Mg(OH) 2 . If the heavy calcined magnesia — magnesii oxidum 
ponderosum — be used instead of the light magnesia, the ten- 
dency to gelatinization will be greatly obviated. Sometimes 
even when the light magnesia is used, no gelatinization takes 
place. This is due to the sad fact that in some drug-stores 
magnesia is handled so carelessly (left in open vessels, in a 
moist atmosphere, etc.), that in a short time the magnesia is 
no longer magnesia, but magnesium carbonate (that is, hydro- 
carbonate), and this latter does not gelatinize with water. I 
have seen many such samples of "magnesia." 

14. Spir. Ammon. Armat 3 ij 

Spir. Menth. Piper 3 j 

Aquae Caleis 3 V J 

$,: J ss after meals. 



PRESCRIPTION INCOMPATIBILITIES 23 

A slight precipitate of calcium carbonate will be formed, 
due to the ammonium carbonate in the aromatic spirit. The 
oils of both spirits will be precipitated by the lime water, 
making a milky mixture ; an inelegant combination but one 
that may be dispensed with a "shake" label. 

15. Acidi Carbol gtt. xx 

Natrii Bibor 5 ij 

Natrii Bicarb 3 ij 

Glyeerini 5 j 

Aquae ad J viij 

S. : Use with nasal douche. 

This is practically the well-known Dobell's solution, only 
modified in the proportions of the ingredients. An efferves- 
cence takes place, due to the evolution of carbon dioxide. 
What is this evolution due to? "To the action of the car- 
bolic acid on the sodium bicarbonate," many would answer. 
No ; it is caused by the action of the boric acid on the sodium 
bicarbonate ; the boric acid being formed by the action of the 
glycerin on the borax. A full discussion of this subject will 
be found in another prescription. 

16. Potassii Iodidi 3 v 

Tr. Ferri Chloridi 5 iij 

Aquae ad J * v 

S. : 3 j t.i.d. p.c. 
It is not advisable to dispense this prescription, as a con- 
siderable amount of iodine is liberated ; not only by the free 
hydrochloric acid present in the tincture, but by the ferric 
chloride itself, thus: 

2KI + Fe 2 Cl 6 = 2FeCL + 2KC1 + L 

It Is Best Not to Prescribe Tincture of Ferric Chloride 
with Potassium Iodide. 

17. Potass. Brom. 

Sodii Brom aa 3 ij 

Aquae Camphorae , $ iv 



24 PRESCRIPTION INCOMPATIBILITIES 

While camphor is soluble to a very slight extent in water, 
it is almost absolutely insoluble in solutions of salts. In 
this prescription it is therefore precipitated out, floating on 
the top of the liquid or adhering to the bottle as a fine scum. 

Salts Should Not Be Prescribed to Be Dissolved in 
Camphor Water, Particularly in Concentrated Solutions. 

18. Quinin. Bisulph 5 i 

Amm. Carbon 5 i 

Syr. Simpl § i 

Aquae Cinnam 3 ij 

S. : 3 i doses. 

Attention has been called to this incompatible prescription 
times without number, nevertheless it seems to be a favorite 
with many physicians. Why physicians will prescribe the 
most soluble quinine salt and then precipitate it is beyond 
comprehension. There is only one explanation for it: the 
physician is not aware that a precipitation takes place. The 
quinine bisulphate, being seventy times more soluble than 
the sulphate, dissolves easily in the prescribed quantity of 
water; but the ammonium carbonate (like all alkaline car- 
bonates) causes a precipitate of alkaloidal quinine. 

Alkaloidal Salts Are Thrown Out of Solution by Al- 
kaline Hydroxides and Carbonates. 

19. Hydrarg. Bichlor gr. vj 

Syrup Hypophosphit 3 ij 

Syr. Sarsap. Co 3 j 

Aquae Menthae Pip J j 

S. : 3 j 4 times a day. 

This prescription is absolutely incompatible. The hypo 
phosphites are strong reducing agents, and the corrosive sub- 
limate is entirely reduced : first to calomel and then to metal- 
lic mercury. Either the corrosive sublimate or the hypophos- 
phites must be omitted. 

Corrosive Sublimate and Hypqphosphites Are Abso- 
lutely Incompatible, 



PRESCRIPTION INCOMPATIBILITIES 25 

20. Argenti Nitratis gr. iv 

Syr. Hypophosphit 5 j 

Aquae Dest q.s. ad J iv 

S. : 3 j after meals. 
This prescription, too, is absolutely incompatible. The 
hypophosphites reduce the silver nitrate to black metallic 
silver. The organic constituents of the syrup also help along 
the decomposition. There is no way of dispensing the above, 
except by leaving out either the first or second ingredient. 
The method of administering silver nitrate in solution is irra- 
tional. On coming in contact with the saliva and the secre- 
tion from the esophagus, the nitrate becomes almost entirely 
decomposed. If an effect on the bowels or a systemic effect 
is desired, the best method is to administer the remedy in the 
form of enteric pills ; i. e., pills coated with salol or keratin. 

21. Cocain. Hydrochlor gr. xx 

Atropin. Sulph gr. ijss 

Aconitin. Nitr gr. j 

Collodion 3 iv 

S. : Paint over painful spots when pain is acute. 
As cocaine hydrochloride is practically insoluble in ether, 
and as collodion consists of gun-cotton dissolved in a mixture 
of 3 volumes of ether and 1 of alcohol, the alkaloidal salt 
will not dissolve. One of two things may be done: Either 
dissolve the cocaine and other alkaloidal salts in a little alco- 
hol (it would require about l 1 /^ dr.), and mix the solution 
with the collodion; or employ alkaloidal cocaine, which is 
very soluble in ether. The latter course is preferable. The 
two last alkaloidal preparations need not be changed, as they 
are in such small quantity that the alcohol present in the 
collodion will dissolve them without much difficulty. 

22. Sol. Magendie 

Sol. Fowleri aa 8.0 

S.: Gtt. viii t.i.d. p. c. 
"Well do I remember this prescription, as it was the first 
incompatible one I ever saw. It was almost at the very com- 



26 PRESCRIPTION INCOMPATIBILITIES 

mencement of my pharmaceutical career. The proprietor 
mixed the two solutions, affixed the label, but, on delivering 
it, noticed a precipitate throughout the entire bottle. He 
seemed to be surprised, and went again behind the counter, 
mixed the solutions in different order, but with the same re- 
sult. After two or three more unsuccessful attempts, I was 
sent to the doctor. "Oh, well, if they don't go well together, 
leave out the morphine," said the doctor. Thus, ignorance 
deprived the patient of the ingredient which he was prob- 
ably in need of. Alkaloids, as we already know, are precip- 
itated by alkalies, their hydroxides, carbonates, and bicar- 
bonates ; Fowler 's solution contains free potassium carbonate 
(potassium bicarbonate is used, but on being boiled becomes 
converted into carbonate) ; the pure alkaloid morphine pre- 
cipitates. A few drops of diluted HC1 added to the arsenic 
solution, before it is mixed with the morphine solution, will 
prevent precipitation, because it will neutralize the potassium 
carbonate. 



23. Antipyrini gr. 

Syr. Ipecac 3 iiss 

Syr. Prun. Virgin 3 ss 

Aquae ad 3 ii 

S. : 3 i 4 x a day. 
A flocculent precipitate is formed, due to the tannic acid of 
the wild cherry combining with the antipyrine. The latter 
is a synthetic base, behaving in most respects as the alkaloids 
do, which, as we saw before, are precipitated by tannic acid. 
Though the mixture might be dispensed with a ' ' shake ' ' label, 
it is better to call the physician's attention to the fact, so 
that he may in the future substitute another sj^rup for that 
of wild cherry. 

24. Antipyrini gr. xl 

Spir. Aetheris Nitr , . . . . 3 ss 

Spir. Frumenti , , , , . . 3 ss 

Syr. Tolutani 3 i 

S.i 3iq. 2 h. 



PRESCRIPTION INCOMPATIBILITIES 27 

This prescription should not be dispensed under any con- 
sideration. So it was taught formerly, but we are not so 
strict now on this point. Antipyrine with sweet spirit of 
niter forms a grass-green solution which is claimed to be 
poisonous. The exact nature of the compound formed has 
not as yet been established. The poisonousness of that com- 
pound has also been disputed, and is in fact denied alto- 
gether, but it is best to be on the safe side, and not dispense 
the combination. 

Antipyrin Should Not Be Dispensed with Spirit of 
Nitrous Ether. 

25. Antipyrini 3 ij 

Sodii Salicyl 3 iv 

Div. in Pulv. No. xij. 

Antipyrine and sodium salicylate should not be prescribed 
in powder form, as liquefaction often occurs, especially in 
damp weather. I have seen this prescription dispensed, and 
when the box reached the patient, there were only a few 
thoroughly soaked papers in it; the patient had to send for 
other powders. I reported a case in the New York Medical 
Journal where the prescribing of just those powders had 
rather disagreeable consequences for the physician. 

Antipyrin and Sodium Salicylate Should Not Be Pre- 
scribed Together in Powder Form. 

26. Potass. Iodidi 3 ij 

Spir. Aetheris Nitr § iss 

Syrupi % i 

Aquae ad J iv 

S. : 3 i q. 2 h. 

Potassium iodide and nitrous ether should never be pre- 
scribed together, because iodine is set free by the acids usually 
present in the nitrous ether. No matter how fresh the spirit 
of nitrous ether may be, the liberation of iodine and discolora- 
tion of the mixture are sure to take place within a very short 
time. Neutralizing the spirit with potassium bicarbonate will 



28 PKESCRIPTION INCOMPATIBILITIES 

not remedy the evil. I experimented in that line, but never 
succeeded in making a permanent mixture from those two 
ingredients. The question in a recent Board of Pharmacy 
examination : ' ' What happens in a mixture containing potas- 
sium iodide and a decomposed sample of spirit of nitrous 
ether ? " is therefore misleading, as there is no line of demar- 
cation between a decomposed and a non-decomposed sample 
of sweet spirit of niter. 

Potassium Iodide, as Well as Other Iodides, Is Incom- 
patible with Spirit of Nitrous Ether. 

27. Hydrarg. Oxidi Flavi gr. v 

Cocainae Hydrochlor <•- gr. iv 

Ungt. Aq. Rosae 3 ss 

S.: Eye salve. Apply at night. 

The physician prescribes here the cocaine with the inten- 
tion of diminishing any pain or burning which the oxide of 
mercury may produce on the inflamed lids and. conjunctivae. 
The result obtained is just the reverse of the expected one. 
The salve has proved exceedingly irritating to the eyes. The 
cause of this is the formation of some mercurous and mercuric 
oxy chloride. The physician's attention should be called to 
this fact, and if he insists on having cocaine, the pure alka- 
loid should be substituted for the hydrochloride. 

28. Cocainae Hydrochlor gr. v 

Sod. Biboratis gr. x 

Aq. Destillatae 5 i 

M.F. Collyrium. 

The sodium borate, which has an alkaline reaction, precip- 
itates the cocaine in alkaloidal form. The proper way to do 
is to substitute an equal quantity of boric acid for the borax, 
or we may add a little glycerin. The latter decomposes the 
borax, yielding sodium metaborate and boric acid, and the 
solution being no longer alkaline, no precipitation will take 
place. The action of glycerin on borax will be fully dis- 
cussed in another prescription. 



PRESCRIPTION INCOMPATIBILITIES 29 

29. Quin. Sulphatis 3 iss 

Acidi Sulph. Dil 3 ii 

Sodii Salicyl 3 ss 

Syrupi ?i 

Aquae ad § iv 

I once watched a junior compound this prescription. He 
put the quinine in a mortar, added some water, and then the 
dilute sulphuric acid; to this clear solution he added the 
sodium salicylate, and lo ! a thick mass resulted. He began 
to triturate vigorously with the pestle, but the more he 
triturated the more solid and pasty the mass became. He 
then began nervously to add some more sulphuric acid, think- 
ing thereby to dissolve the mass ; but the more acid he added, 
the worse the matter seemed to become. The entire con- 
tents of the mortar had to be thrown away. If made up in 
a bottle, both the contents and the bottle have to be thrown 
away, as the bottle cannot even be cleaned, so sticky is the 
mass. The sulphuric acid here does double mischief; first, it 
dissolves the quinine sulphate, thus permitting it to fully 
react with some of the sodium salicylate, forming insoluble 
quinine salicylate; secondly, it decomposes the rest of the 
sodium salicylate, forming sodium sulphate and salicylic acid, 
the latter of which precipitates. In order to be able to dis- 
pense this prescription in a more or less presentable form, 
the sulphuric acid must be left out. The quinine sulphate is 
rubbed up with about half of the water, the sodium salicylate 
is dissolved in the other half and mixed with the syrup, and 
this solution is gradually added to the quinine mixture with 
agitation. The whole is dispensed with a "shake" label. In 
this way practically no reaction takes place, the quinine sul- 
phate being kept in suspension instead of being dissolved. 

Soluble Quinine Salts Are Incompatible with Soluble 
Salicylates, the Insoluble Quinine Salicylate Being 
Formed. 



30 PRESCRIPTION INCOMPATIBILITIES 

30. Quin. Sulphatis 5 i 

Acidi Sulph. Dil 3 ii 

Sodii Acetatis J ss 

Syr. Rubi Idaei 5 i 

Aquae ad J viij 

What has been said in explanation of the previous prescrip- 
tion applies with equal force to this one. The bulky quinine 
acetate precipitates, and the balance of the sodium acetate is 
decomposed by the sulphuric acid, with the formation of 
sodium sulphate and acetic acid. The prescription is to be 
compounded like the previous one, i. e., the sulphuric acid 
must be omitted. 

Soluble Quinine Salts Are Incompatible with Soluble 
Acetates. 

31. Hydrarg. Chlorat. V.h.par 8 

S.: For doctor's use. 

Late one evening, when about to retire, a messenger came 
with a note from a druggist, requesting an explanation of 
the above "mysterious" prescription. There is nothing mys- 
terious about it. It means Hydrargyrum Chloratum via 
Humdda paratum, that is, calomel prepared by the wet proc- 
ess, or by precipitation. The ordinary calomel is, as we 
know, prepared by sublimation (vapor e partum). The calo- 
mel prepared by the wet process is in a much finer amorphous 
condition, and is, therefore, preferred by some physicians; 
for insufflating into the eyes, for instance, it is superior to 
the ordinary variety. 

32. Aqua f ontana 100 grms 

Ilia repetita 45 " 

Eadem destillata 12 " 

Hydrogenii protoxidi 0.5 " 

Nil aliud gtt vi ! 

Sig. One drop in a teaspoonful of water thrice daily. 

All physicians know what a placebo is, but many druggists 
do not. It is a harmless or inert remedy which we are some- 



PRESCRIPTION INCOMPATIBILITIES 31 

times obliged to give to nervous patients, whom we feel need 
no medicine, but who think they must take something ; bread 
pills, colored water, etc., are placebos; the word placebo 
means in Latin: I will please. The above placebo is reported 
to have cured a large number of neurotic and cranky women 
of their imaginary ills. It was prescribed for one court lady 
by Napoleon Ill's physician and was greatly in vogue with 
the grandes dames de la cour. 

As a few of my readers (very, very few, of course!) may 
not be strong in Latin, I will translate the ingredients into 
English: (1) Spring water, (2) the same repeated, (3) the 
same distilled, (4) hydrogen protoxide (i. e., water) ; (5) 
nothing else. 

Had the demon of curiosity not taken possession of the 
grande dame, she might have gone on to her last day praising 
and presenting to her friends the great prescription of the 
famous Dr. N. But she could not resist the temptation. She 
wanted to know what the wonderful ingredients were. She 
presented the prescription to numerous plrysicians and phar- 
macists, but they evaded a direct answer or said that those 
were rare medicaments the nature of which she would not 
understand. At last she found a druggist, who for a con- 
siderable sum of money revealed the fatal secret. The wrath 
of the grand lady against the physician can be better imag- 
ined than described. 

33. Tr. Ferri Chlor. 3 ij 

Sod. Salicyl 3 iv 

Glycerini 3 i 

Aquae ad % iij 

S. : 3 i t.i.d. p.c. 

The salicylates are incompatible with ferric salts, forming 
ferric salicylate, of a deep violet-blue color. This prescription 
may be dispensed but it is better to inform the physician 
of the resulting reaction. 

Ferric Salts Are Incompatible with Salicylates: a 
Deep Violet Blue Color Results. 



32 PRESCRIPTION INCOMPATIBILITIES 

34. Quiii. Sulph 3 i 

Ac. Sulphurici Dil q.s. 

Tr. Ferri. Chlor 3 ij 

Glycerini J i 

Aquae ad J iij 

S. : 3 i t.i.d. p.c. 

As the physician has here evidently prescribed the diluted 
sulphuric acid merely as a solvent for the quinine, it is best 
left out, as tincture of ferric chloride (on account of its con- 
taining free HC1) is an excellent solvent for quinine salts 
in general. 

35. Morphin. Sulph gr. j 

Camphorae gr. xx 

Mentholis * gr. xv 

Pulv. Althaeae gr. xl 

Div. in pulv. No. x. 

Menthol and camphor, when rubbed together or when long 
in contact, become liquefied. There is a way, however, of 
obviating the difficulty: to rub the camphor with a portion 
of the althea, the menthol with the remainder ; then to divide 
the camphor and menthol separately into ten powders (one 
kind is wrapped outside with blue paper). The patient is 
directed to take one of each kind of powder at a time. I 
do not particularly recommend this method, though I can 
see no special objection to it. 

Menthol and Camphor Liquefy and Are Therefore In- 
compatible When Prescribed in Powder Form. 

36. Morphin. Sulph gr. ij 

Spir. Ammon. Aromat 3 ij 

Aq. Menth. Piper 3 v j 

S.: 3 j when required. 

This prescription is a dangerous one to dispense. The 
ammonia will precipitate the morphine. As I said before, 
poisonous principles should never be dispensed in a state of 
suspension. In pouring out the medicine, a dose equivalent 



PRESCRIPTION INCOMPATIBILITIES 33 

to one-third, one-half, or even a whole grain, may easily 
get into the spoon. 
Alkaloids Are Incompatible with Alkalies. 

37. Antipyrini gr. viij 

Calomelanos gr. v 

Sacch. Laetis gr. v 

Antipyrine and calomel are considered incompatible. When 
rubbed together or in contact, in the presence of moisture 
at a somewhat elevated temperature, corrosive sublimate is 
apt to form. The exact chemical reaction which takes place 
has not yet been established with absolute certainty, but it 
may be expressed by the following equation: 

3Hg 2 Ch + 2C 1 iH 12 N 2 + ILO = 

Calomel Antipyrine Water 

Hg 2 + 2HgCL + Hg 2 + 2C li H 12 N 2 0. HC1 

Mercurous Mercuric Metallic Antipyrine 

Oxide Chloride Mercury Hydrochlor. 

As but a small proportion of the calomel is converted into 
corrosive sublimate, little hesitancy need be had in dispensing 
antipyrine and calomel, when the latter is prescribed in small 
doses, as in fractional parts of a grain. (See two articles on 
this subject, by the writer, in the N. Y. Med. Jour. Vol. LXIY, 
p. 752; and Vol. LXV, p. 223.) I now consider the whole 
question of antipyrine and calomel of academic interest only. 
In practice I do not hesitate to prescribe them. 

38. Plumbi Acetatis^i __ _ . 
Zinci Sulph. J aa 5 3 

Div. in pulv. No. xii. 

If the two ingredients be rubbed together in a mortar a 
moist mass results, due to chemical interaction : ZnS0 4 -f Pb 
(C 2 H 3 2 ) 2 = Zn(C 2 H 3 2 ) 2 -f- PbS0 4 and the consequent lib- 
eration of the water of crystallization. The only thing to do 
is to dispense the lead acetate and the zinc sulphate in sep- 
arate, differently colored papers, and to direct the patient to 
dissolve one of each in the prescribed amount of water. 



34 PRESCRIPTION INCOMPATIBILITIES 

Zinc Sulphate and Lead Acetate Become Deliquescent 
When Rubbed Together. 

39. Sodii Salicyl 3 i j 

Syr. Rub. Idaei 3 ij 

Aquae Gaultheriae J iv 

Syrup of raspberry contains a small amount of citric acid, 
which will decompose a small quantity of the salicylate with 
the formation of sodium citrate and the precipitation of sal- 
icylic acid. As the quantity is very small, the prescription 
may be dispensed as it is, or it may be filtered. 

40. Quin. Sulph 3 i 

Acidi Sulph. Dil 3 ii 

Potass. Iodidi 3 v 

Syrupi J jss 

Aquae ad J iv 

This is an example of double incompatibility. The sul- 
phuric acid is incompatible with potassium iodide, forming 
hydriodic acid, which easily decomposes, iodine being set 
free; and the potassium iodide, with the free iodine, attacks 
the quinine sulphate, precipitating it as quinine hydriodide 
(or "iodide"). In this case it is best to call the physician's 
attention to the incompatibility. If he insists on having the 
quinine and the iodide in the same mixture, the sulphuric 
acid must be left out; the quinine is rubbed up with a por- 
tion of the water, the potassium iodide dissolved in the re- 
mainder, this solution gradually added to the quinine mix- 
ture, and the whole dispensed as a "shake" mixture. Only 
a small quantity of quinine hydriodide will be formed, the 
solubility of quinine sulphate being but slight (1 in 725). 

41. Panereatin 3 j 

Bism. Subnitr J ss 

Sodii Bicarbon 3 ss 

Pulv. Aromatici gr. xxiv 

Glycerini 3 ss 

Aquae ad 3 iij 



PRESCRIPTION INCOMPATIBILITIES 35 

This mixture frequently explodes, especially when standing 
in a warm place. Occasionally the bottle is shattered into 
numerous bits. The reason is referable to the liberation of 
nitric acid from the bismuth subnitrate, which in its turn acts 
on the sodium bicarbonate, with the liberation of carbon diox- 
ide. The equation may be expressed as follows : 

1. 2BIONOs + 2ILO = BIONO, + Bi(OH) 3 + HNO. 
Bismuth Water Bis. Bis. Nitric 
Subnitrate Subnitrate Hydroxide Acid 

2. NaHCO, + HNO, = NaN0 3 + H2O + CO* 

Sod. Nitric Sod. Water Carbon 

Bicarb. Acid Nitrate Diox. 

As the reactions here described will almost invariably take 
place sooner or later, the physician's attention should be 
called to the fact, and the suggestion be made to employ the 
subcarbonate instead of the subnitrate of bismuth. 

42. Strychn. Sulphatis gr. ij 

Potass. Bromidi 3 j 

Syrupi 3 iss 

Aquae ad 3 vj 

Potassium bromide, as usually found on the markets, is in- 
compatible with strychnine, as it is with most alkaloids, pre- 
cipitating them in the form of bromides. Chemically pure 
bromides (and iodides) do not precipitate the alkaloids as 
readily as do the commercial articles. The latter, in order 
to be more stable, are crystallized from alkaline solutions, and 
consequently contain some hydroxide; and alkaline hydrox- 
ides are stronger alkaloidal precipitants than the bromides 
or iodides. To dispense this prescription with the undissolved 
strychnine bromide would be manifestly unsafe, as too large 
a dose of strychnine may be poured out in one spoon. 

43. Strychn. Sulphatis gr. ij 

Potass. Bromidi J j 

Syrupi 3 j 

Spir. Fruinenti 3 i j 

Aquae ad 3 V J 



36 PRESCRIPTION INCOMPATIBILITIES 

This prescription may be dispensed, as the alcohol con- 
tained therein is sufficient to prevent the precipitation of 
strychnine bromide. Strychnine sulphate and potassium 
bromide may be prescribed together, if the vehicle contains 
from twelve to fifteen per cent, of alcohol. 

44. Strychn. Sulph gr. j 

Sodii Phosphatis 3 j 

Magnes. Sulph § j 

Aquae 3 viij 

S.: J ss three times a day. 
This is a favorite prescription of an old practitioner for 
"catarrh," and atony of the stomach, and for loss of appe- 
tite. The dose of strychnine, which is rather large, has in 
no instance produced any bad effects, he claims. Sodium 
phosphate, being of alkaline reaction, will precipitate the 
strychnine. This can be easily prevented by adding a few 
drops of phosphoric acid, so as to neutralize the alkalinity 
of the sodium phosphate. 

45. Argenti Nitratis gr. vj 

Ext. Glycyrrhizae gr. xij 

Pulv. Althaeae q.s. 

M. ft. pil. Ko. xij. 
If the full medicinal virtues of the silver nitrate are to be 
preserved, it should not be prescribed with organic matter, 
by which it is readily decomposed. Licorice or althea should, 
therefore, not be used as excipients in silver nitrate pills. 
Still more objectionable is an excipient prescribed by physi- 
cians of the old school. I refer to "mica panis," or crumb 
of bread. Beside being organic matter, bread contains salt 
(sodium chloride), which effectually decomposes the nitrate, 
silver chloride resulting. The best excipient to use in making 
these pills is kaolin or argilla alba (which is, chemically, a 
silicate of aluminum), with a minute quantity of anhydrous 
woolfat. Instead of the woolfat, some recommend vaselin; 
but the latter possesses no adhesive properties, and it is diffi- 
cult to make a presentable pill mass with kaolin and vaselin, 



PRESCRIPTION INCOMPATIBILITIES 37 

Silver Nitrate Is Incompatible with Organic Sub- 
stances. 

46. Argenti Nitratis gr. x 

Acidi Carboliei gr. vj 

• Hydrastis Aquosi 3 ss 

Glycerini 3 ij 

Aquae q.s. ad J iv 

S. : Use as an injection. 
This is a favorite prescription of a prominent Brooklyn 
physician. He claims he gets good results from it, but it is 
certainly not the silver nitrate that gives the good results, 
as there is no nitrate left in the prescription; it becomes 
decomposed by the organic substances. If we want silver 
nitrate in solution with its unimpaired properties, only dis- 
tilled water should be used, nothing else. 

47. Argenti Oxidi gr. x 

Ext. Glycyrrhiz. Pulv gr. xv 

Glycerini q.s. 

M. ft. pil. No. xxx. 
Not only is silver oxide incompatible with organic matter, 
being decomposed by it, but the liberation of oxygen may 
cause a miniature explosion. Perforating the lid of the box 
or dispensing in a loosely stoppered vial is no remedy, be- 
cause in being evolved from the pills, the gas often breaks 
the pills into little bits. The real remedy is to use no organic 
excipients, only kaolin (with a bit of anhydrous woolfat), as 
recommended for pills of silver nitrate. 

48. Argenti Nitratis gr. v 

Sodii Chloridi gr. x 

Aquae Destillatae 3 iv 

S. : Use an injection. 

This prescription was written by a medical practitioner of 

the Eclectic School, and was dispensed by a druggist, after 

having been filtered. The doctor having learned that the 

severe burning caused by silver nitrate can be effectually 



38 PRESCRIPTION INCOMPATIBILITIES 

stopped by a subsequent injection or application of a solu- 
tion of sodium chloride, thought he would simplify matters 
and save time and labor by ordering both ingredients in the 
same prescription. That there was no silver nitrate left in 
the bottle, need not be dwelt upon, as it is almost presump- 
tion to tell intelligent readers that sodium chloride decom- 
poses silver nitrate into the insoluble and inert silver 
chloride. 

Silver Nitrate Is Incompatible with Soluble Chlorides. 

49. Bismuthi Subnitr 3 ij 

Sodii Bicarbon 5 i 

Mueil. Acaciae q.s. 

Div. into pil. No. xxiv. 
As explained in Prescription No. 41, bismuth subnitrate 
and sodium bicarbonate are somewhat incompatible, carbon 
dioxide being evolved. These pills would swell and break 
up. This may be avoided by using the subcarbonate of bis- 
muth instead of the subnitrate, or by using an excipient prac- 
tically free from water, such as glycerite of starch. 

50. Acidi Chromiei 3 ss 

Aleoholis 3 ij 

S. : Use externally. 

Of all the oxidizing official chemicals, such as potassium 
chlorate, potassium permanganate, etc., chromic acid is the 
most so. This prescription should not be compounded under 
any circumstances. Chromic acid should never be brought in 
contact with any kind of organic oxidizable matter, as a 
dangerous explosion may take place. Great care should also 
be taken in handling it, as it destroys any animal tissue with 
which it comes in contact. 

Chromic Acid (Chromium Trioxide) Should Never Be 
Prescribed with Organic Substances. 

51. Potass. Permangan gr. x 

Glycerini 3 J 

Aquae 3 ij 

S. : Use externally. 



PRESCRIPTION INCOMPATIBILITIES 39 

52. Potass. Permangan gr. xxx 

Pulv. Liquiritiae 

Ext. Gentianae aa q.s. 

M. ft. massa in pilul. No. xxx dividenda. 
The remarks made regarding silver nitrate are applicable 
with still greater force to potassium permanganate. The 
latter is exceedingly sensitive to organic matter ; it gives off its 
excess value as an oxidizer with the utmost readiness. Its 
value as an oxidizer and disinfectant depends upon the oxy- 
gen it liberates in statu nascendi. It is self-evident, there- 
fore, that in combining it with organic matter (or with oxidiz- 
able inorganic matter) its usefulness is entirely destroyed. 
When ordered in solution, it should be prescribed with dis- 
tilled water only. For pills, kaolin with anhydrous woolfat 
is to be employed as the excipient. Or, what is preferable, 
the permanganate is intimately mixed with kaolin or talcum 
and filled into capsules (dry). It is also worth remembering 
that when a solution of potassium permanganate is used exter- 
nally as an application, a considerable portion of it is de- 
stroyed by contact with the cotton swabs, or lint employed as 
a dressing, etc. 

53. Pulv. Calaminaris 
Zinci Oxidi 

Acidi Carbolici 3 iv 

Aquae Calcis 3 ij 

Aquae Rosae q.s. ad § iv 

Apply frequently and freely. 
There is no incompatibility in the prescription, but it is 
a good example of how a printer's error, combined with 
ignorance on the part of physician and druggist, may lead 
to a disastrous accident. I was asked by a physician to see 
in consultation a baby, to whom he had the day before pre- 
scribed the above lotion. (The child had an eczematous and 
urticarial eruption.) On calling the next morning, the child 
was much worse ; it had screamed badly when the lotion was 
applied, refused to take the breast, had passed no water, was 



1 aa 3 iss 



40 PRESCRIPTION INCOMPATIBILITIES 

very restless; in short, it seemed dangerously ill. By the 
aid of a catheter, I drew off some urine, which was of a green- 
ish color and highly albuminous. I diagnosticated carbolic 
acid poisoning, instituted the proper treatment, and in three 
days the child was well. I asked him what he had pre- 
scribed; on seeing the prescription, I told him that the car- 
bolic acid was excessive; that this was a well-known for- 
mula, but that y 2 dr., not 4 dr. is always used to 4 ozs. He 
afterward mailed me the page from the journal from which 
he had copied the formula, and indeed the formula had it 
% oz. ! Of course, both the physician and the pharmacist are 
to blame in this instance. The pharmacist should have borne 
in mind that half an ounce of carbolic acid cannot be dis- 
solved in three and one-half ounces of water, and that it is 
very dangerous — in fact, it is absolutely inadmissible — to 
dispense a mixture with carbolic acid held in suspension, i. e., 
not in perfect solution. 

54. Zinci Sulphatis gr. xxiv 

Plumbi Acetatis 3 j 

Aquae 3 vi 

S. : Use externally as directed. 

Though this prescription is incompatible, it is one of the 
most common examples of desirable or intentional incom- 
patibility. Many practitioners stick their faith to the above 
recipe, considering it a ne-plus-ultra injection in gonorrhea; 
and there seems to be no doubt that the sulphate of lead 
exerts a beneficial protective influence on the mucous mem- 
brane of the urethral canal, while the zinc acetate has a 
non-irritating astringent effect. The reaction which takes 
place is a very simple one: 

ZnS04 + Pb(C 2 H 3 2 ) 2 = Zn(C 2 H 3 2 ) 2 + PbSO* 

There is no difficulty in making up this prescription. But 
how often, in seeing this prescription made, was I able to 
distinguish between the good pharmacist and the bad phar- 
macist. There is not a thing, be it ever so small, that cannot 



PRESCRIPTION INCOMPATIBILITIES 41 

be done either rightly or wrongly. An ounce of zinc oint- 
ment may be made well or poorly. The careless pharmacist, 
with slipshod methods, with no love for his profession, will 
take the zinc sulphate and the lead acetate and throw them 
into a bottle, which he will then fill with water and dispense, 
after a few efforts at shaking. This will make a lumpy mix- 
ture, which may prove quite irritating. The real, true phar- 
macist, who wants to prepare this prescription lege artis, 
will proceed as follows : He will boil 6 fl. ozs. of distilled 
water and dissolve the zinc sulphate in 3 fl. ozs., of it, and 
the lead acetate in the remaining 3 fl. ozs. Should the solu- 
tion of the latter be somewhat cloudy, in consequence of the 
exposure of the lead acetate to the air (lead acetate eagerly 
absorbs carbon dioxide, forming lead carbonate), he will add 
a drop or two of acetic acid ; he will then filter the solutions 
separately, and will mix the filtrates gradually, under con- 
stant agitation. Prepared in this manner, the lead sulphate 
will be in a very fine state of subdivision. What a pity that 
not all pharmacists are imbued with the sacredness of their 
calling. But in most cases it is thoughtlessness. If they but 
knew what a difference it may make in the results of treat- 
ment, they would devote a little more care and attention 
to the performance of their professional duties. 

55. Hydrarg. Cblor. Corrosivi gr. vj 

Kali Iodati 3 ij 

Ckinini Mur 3 i j 

Stryck. Sulph gr. ij 

Tr. Gentian. Comp J j 

Syr. Sarsap. Comp J ij 

Aquae ad J v j 

This prescription belongs to a class which is unfortunately 
very common. The physicians of the younger generation 
have it impressed upon their minds that for a syphilitic pa- 
tient tonic treatment is just as 'important as the specific one. 
Consequently, they are \evy apt to attempt to combine in 
one mixture the mercurials and iodides with the tonic alka- 



42 PRESCRIPTION INCOMPATIBILITIES 

loids. Had the physician tried his utmost to get the quinine 
and the strychnine precipitated he could not have done any 
better than to prescribe them with corrosive sublimate and 
potassium iodide. Each of these chemicals alone will pre- 
cipitate alkaloids, but when combined they form the so-called 
" Mayer's solution of iodohydrargyrate of potassium," which 
is one of the most potent general alkaloidal precipitants. 
To dispense the prescription as written is certainly a dan- 
gerous procedure, as the patient may get too large a dose of 
strychnine. The best thing is to communicate with the physi- 
cian. If this is not feasible, I would leave out the strychnine 
on my own responsibility, and impress upon the patient the 
importance of shaking the bottle each time ; and I would in- 
form the physician by mail, so that he can order the strych- 
nine separately, in the form of pills or tablets. 

Alkaloids Should Never Be Prescribed in a Mixture 
Containing Mercuric Chloride and Potassium Iodide. 
There Is Sure to Be a Mutual Precipitation. 

56. Hydrarg. Bichlor 0.12 

Potass. Iodidi 10.0 

Tr. Cinchon. Comp 60.0 

Syr. Sarsap. Comp 15.0 

Aquae q.s. ad 120.0 

The remarks made in the preceding prescription apply to 
this one as well, except, of course, that there are no poison- 
ous alkaloids. The bichloride and the iodide will precipitate 
the alkaloids of the cinchona. The bichloride will also be 
affected by the tannic acid in the cinchona. (Corrosive sub- 
limate is a very delicate agent, and should be prescribed as 
little in combination as possible.) But, as many physicians 
insist on prescribing the above mixture, it should be dis- 
pensed with a "shake" label. 

57. Tr. Ferri. Mur 10.0 

Tr. Chinae 100.0 

This is a favorite prescription with many German prac- 



PRESCRIPTION INCOMPATIBILITIES 43 

titioners, and is known in some drug stores by the name 
"German ink." The cincho-tannic acid combines with the 
iron, producing tannate of iron, yielding a greenish-black, 
inky mixture. But as the physicians prescribing it are aware 
of the change of color in this mixture, and do not mind it, 
the pharmacist must not interfere. After all, appearance is 
not everything ; and, as some one has said, ' ' a nasty medicine 
is preferable to a nice funeral." 

58. Quin. Sulph 3 i 

Acidi Sulph. Dil q.s. 

Ext. Glycyrrhiz. Fl J ss 

Syrupi I i 

Aquae ad 3 iii 

This is an old and well-known prescription incompatibility. 
The dilute sulphuric acid works double mischief. First, by 
dissolving the quinine, it renders the mixture intensely bit- 
ter; secondly, by precipitating the glycyrrhizin from the 
fluidextract of glycyrrhiza, the sweetening or disguising 
property of the latter is completely destroyed. Omit the sul- 
phuric acid, and dispense the prescription as a "shake" 
mixture. 

59. Sol. Magendie 3 ii 

Sol. Potass. Iodidi Satur 3 vi 

S.: Gtt. x t.i.d. p.c. 
The pharmacist should refuse to dispense this prescription. 
"While the dispensing of a non-poisonous alkaloid like quinine 
in an undissolved form is more a matter of esthetics than 
anything else, it is entirely different when we have poisonous 
principles to deal with. Poisonous alkaloids are to be dis- 
pensed in liquid mixtures only when they are in perfect 
solution and when there is no danger of their subsequent 
precipitation. AYithin a very short time, silky needles will 
begin to deposit, and eventually all the morphine will be 
precipitated out as morphine hydriodide. That it would be 
a very dangerous thing to take this medicine by drops, re- 
quires no argument. 



44 PRESCRIPTION INCOMPATIBILITIES 

CO. Potass. Chloratis 3 iss 

Acidi Hydrochlor 3 i 

Glycerini 3 i 

Aquae ad 3 iv 

S. : As directed, on a cotton swab. 

The making up of this prescription will depend greatly on 
the physician's directions and on the knowledge as to how 
it is to be employed. When prescribed in diphtheria, to be 
used for swabbing the throat, the physician generally wants 
the solution to contain free chlorine. In this case, the pre- 
scription is compounded just as written; i. e., the hydro- 
chloric acid is poured directly on the potassium chlorate 
(crystals). This generates free chlorine. When the reac- 
tion seems to be completed, the water is added, and then 
the glycerin. However, if wanted for internal use, or when 
the evolution of chlorine is not desired, the potassium chlorate 
should be dissolved in the water and mixed with the glycerin, 
and then the hydrochloric acid should be added last. If 
made in this manner, no chlorine will be evolved. 

61. Potass. Chloratis 3 i 

Tr. Ferri Chloridi 3 i 

Glycerini 3 i 

Aquae ad 3 vi 

S.: 3 ss as directed. 
I used to dispense this prescription daily, and several 
times a day, because I knew how it was to be employed; a 
tablespoonful was to be mixed with a cupful of warm water 
and used as gargle. But should the directions not be known, 
the prescription should not be dispensed. Were the dose 
even a teaspoon instead of a tablespoon, I would hardly dis- 
pense it; not because the dose (ten grains) of potassium 
chlorate would be an excessive one — it is rather large, and 
physicians are of late very cautious in administering large 
doses of KC10 3 — but because the chemical is not dissolved; 
and undissolved, potassium chlorate is extremely irritating 
to the throat and stomach. But where the physician is awar* 



PRESCRIPTION INCOMPATIBILITIES 45 

of the circumstances and insists on the prescription being 
dispensed as written, the druggist has no alternative but to 
obey. 

62. Calomelanos gr. v 

Potass. Bromidi gr. v 

Saech. Lactis gr. v 

Ft. tal. doses No. xxx. 
This prescription is a dangerous one, and should not be 
dispensed under any circumstances. A reaction takes place 
between the mercurous chloride and potassium bromide, with 
the formation of mercuric bromide, a very poisonous com- 
pound. The equation is as follows: 

2HgCl + 4KBr = Hg + HgBr. + 2KBR + 2KC1 
Calomel Potass. Mer- Mercuric Potass. Potass. 
Bromide cury Bromide Bromide Chloride 

The presence of water or moisture seems to be necessary 
for the reaction to take place, because if the potassium 
bromide is dried, so that all interstitial moisture is driven 
off, no change occurs in the mixture. The reaction occurs 
immediately, however, on the addition of water (which is 
present also in the gastric juice). Even when administered 
separately, calomel and potassium bromide should not be 
given at too short intervals apart ; a period of one or two 
hours should intervene, so as to avoid the possible danger 
of the formation of mercuric bromide in the stomach. 

63. Sol. Natrii Bicarbon., 25% 3 viij 

S.: Apply externally all over the body, with a piece of 
cotton. 

This is a short prescription, but a very interesting tale 
goes with it. It was presented to me in my early junior 
days. One of the first things I committed to memory — and 
I would recommend all drug-clerks to do the same — was the 
solubility of the commonly employed chemicals. I, therefore, 
saw at once that there was no possibility of making a twenty- 
five per cent, solution of sodium bicarbonate, and so told 



46 PRESCRIPTION INCOMPATIBILITIES 

the proprietor; the strongest solution that can be made is 
about eight per cent. 

' ' Well, ' ' said he, ' ' you have not had very much experience, 
I see; I'll make the solution all right." He then weighed 
out two ounces of sodium bicarbonate, took eight ounces of 
water (the right quantity would have been six ounces), put 
both in a dish, and brought the solution to boiling. A clear 
solution resulted. "But won't it precipitate on cooling?" 
remonstrated I, mildly. "Wait and see." The solution be- 
came cold and remained perfectly clear. With a look of 
triumph, the "boss" delivered it, and very satisfied was he. 
However, the next morning the doctor who prescribed the 
solution came to the store in a perfect rage. We must have 
made a mistake, a terrible mistake; we must have put in 
some poisonous stuff, some caustic ; it nearly killed the baby ; 
the eruption became much worse ; the itching was intolerable, 
etc., etc. 

Now, what had taken place? Simply this: Any bicar- 
bonate in solution, when strongly heated or boiled, becomes 
converted into a carbonate, according to the following equa- 
tion: 

2NaHCOs + heat = Na*C0 3 + CO, + H*0. 

The solution delivered was consequently not one of sodium 
bicarbonate, but a strong solution of sodium carbonate. It 
was to be applied to a little baby that had a slight eruption. 
No wonder that it produced such great injury ! The child 's 
suffering could be allayed only by wrapping the whole body 
in lint soaked in carron oil; and it took quite a long while 
before it got well. My proprietor never afterward dispensed 
a twenty-five per cent, solution of sodium bicarbonate. 

64. Tr. Ferri Chlor 3 ij 

Glyeerini 3 ss 

Aquae Gaultheriae 3 iij 

What will take place in this prescription? It assumes a 
beautiful violet-blue color. What is this due to? Oil of win- 



PRESCRIPTION INCOMPATIBILITIES 47 

tergreen consists principally of methyl salicylate, and all 
salicylates are incompatible with ferric salts, forming ferric 
salicylate, which is of a deep violet-blue color. The reac- 
tion is explained by the following equation: 

2FeCl 3 + 6CH3C7H5O3 = Fe2(CiH.Oi). + 6CH.C1. 

While some physicians may prescribe it, being unfamiliar 
with the facts, I knew one physician who used to prescribe 
this mixture purposely, in order not to let his patients know 
that they were taking iron. 

65. Tr. Ferri Chloridi 3 i j 

Kali Chloratis 3 j 

Antipyrini q.s. 

Glycerini 5 j 

Aquae ad J iij 

The "antipyrini, q. s.," shows that the physician wants 
the antipyrin only for the color it produces with the iron. 
As the "yellow throat mixture" is too well known, some 
physicians prefer to make their patients believe that they 
are taking something new. Antipyrin produces a deep-red 
color with ferric salts. 

66. Natrii Salicyl 3 ss 

Spir. Nit. Dulcis J j 

Syr. Simpl J j 

Aquae ad J viij 

When dispensed this is a perfectly clear solution, but grad- 
ually it begins to darken until it is almost black. This dark- 
ening is due to a reaction between the sodium salicylate and 
the spirit of nitrous ether. The patient is likely to bring 
back the mixture, asking if a mistake had not been made, or 
if it did not get spoiled. It is therefore imperative to in- 
form the patient that this mixture will get dark ; he will then 
not be alarmed. The exact nature of the reaction between 
the salicylate and the nitrous ether, as between antipyrin 
and nitrous ether, and many other organic compounds, is 
not well understood. I will remark here that where no de- 



48 PRESCRIPTION INCOMPATIBILITIES 

tails are given as to the reaction which takes place, it is be- 
cause no definite statement can be made. To go into specula- 
tion would lead us too far and would hardly prove very 
useful to the reader. 

67. Ammon. Carbon 3 ij 

Syr. Ipecac 3 ij 

Syr. Scillae 3 ss 

Syr. Prun. Virgin J j 

Aquae ad "J iij 

S.: 3 i q. 3 h. until cough is relieved. 

The acetic acid present in both the syrup of squill and 
the syrup of ipecac will decompose the ammonium carbonate, 
producing ammonium acetate and carbon dioxide. The mix- 
ture should, therefore, be made in a mortar, and poured into 
the bottle only after the evolution of C0 2 has ceased. 

Acids Liberate Carbon Dioxide from Carbonates. 

68. Liq. Plumbi Subacet 3 ij 

Mucil. Acaeiae 3 i y 

Aquae ad J xvj 

S. : Dip a cloth and keep constantly wet. 

Solution of lead subacetate forms such a thick, gelatinous 
mass with mucilage of acacia that a cloth cannot be dipped 
into it or kept constantly moist with it. Two ways are open : 
either to leave the mucilage out, or, better, to substitute lead 
acetate for lead subacetate, as lead acetate gives no pre- 
cipitate with mucilage of acacia. Liq. Plumbi Subacet. being 
about 25 per cent, strong the proper quantity of lead acetate 
would be about half an ounce. 

Solution of Lead Subacetate Gives a Thick Gelatinous 
Precipitate with Mucilage of Acacia. 

68. Acidi Salicylici 3 ij 

Natrii Bicarb 3 jss 

Syr. Aurantii Cort 3 j 

Aquae Menthae : q.s. ad J vj 

According to the books, an acid and an alkali are incom- 



PRESCRIPTION INCOMPATIBILITIES 49 

patible, but this is a kind of incompatibility that physicians 
would do well to practice more than they do. The salicylic 
acid and the sodium bicarbonate react with one another, and 
the freshly formed sodium salicylate is the result, thus: 
NaHCOs + HCtH 5 3 = NaCiH.0, + CO* + H»0. 

The proper way is to dissolve the NaHC0 3 in the water in 
a mortar, add the salicylic acid, stirring until dissolved, fil- 
tering rapidly, adding the syrup and waiting until all the 
C0 2 is expelled before bottling. Many practitioners believe 
that this freshly prepared salicylate is superior to the ready 
made article. That it is more acceptable to the stomach is 
a fact. 

70. Acidi Salicylici 3 v 

Natrii Bicarb q.s. ad saturatiouem 

Syr. Rub. Idaei '. 3 j 

Aquae Gaultheriae B viij 

The physician desires the apothecary to supply the neces- 
sary quantity of sodium bicarbonate to neutralize the sali- 
cylic acid. It cannot be expected that a physician should 
know the proper quantities of alkalies required to neutralize 
certain quantities of acids and vice versa, but the pharma- 
cist should know it; it is his business to know such things, 
and such questions should be met with frequently in our 
Board of Pharmacy examinations. Unfortunately, there are 
many druggists to whom such problems are about as intelli- 
gible as Chinese is. They are not aware even of the fact 
that at the end of the Pharmacopeia there are tables which 
give the exact quantities of acids and alkalies required for 
mutual neutralization. Until our examinations become more 
practical and more stringent, such state of affairs will con- 
tinue to exist. One hundred parts of salicylic acid require 
for complete neutralization 62 parts of sodium bicarbonate; 
for practical purposes it is enough to remember the propor- 
tion of 5 to 3. Consequently, 5 dr. of salicylic will require 
3 dr. (more exactly 3 dr. and 6 grn.) of sodium bicarbonate. 



50 PRESCRIPTION INCOMPATIBILITIES 

The order of procedure is the same as in the previous pre- 
scription. 

71. Extr. Uvae Ursi Fl 3 ss 

Spt. Aetheris Nitrosi J j 

Spt. Juniperi Comp. 

Ext. Tritici Fl aa 3 ij 

Syrupi Simplicis et Aquae aa ad 3 iv 

I know a druggist whom the improper putting up of this 
prescription cost the price of a pair of trousers. The cus- 
tomer put the bottle in his pocket, but returned in a minute 
with the dark liquid trickling down his white trousers, and 
full of angry words at the druggist for his carelessness in 
not corking the bottle properly, etc. The druggist denied the 
allegation, and said it must have been the man's own fault, 
but agreed to make up another bottle without extra charge. 
Unfortunately, while handling this second bottle, the cork 
popped out with quite an explosion, striking the man's fade 
with considerable force, bespattering his white front, etc. 
To avoid any scenes, and to get rid of the man before the 
return of the boss, the poor drug clerk agreed to "settle" 
with the man and return him the prescription. 

I once experimented with a similar mixture to see how 
long the evolution of the gas would last. Fourteen times, 
at gradually increasing intervals, the cork popped out. The 
fifteenth time it stayed in. The gas which is evolved con- 
sists of various oxides of nitrogen. The statement is gen- 
erally made that this evolution of gas is due to the action 
of the nitrous acid on the tannic acid of the uva ursi. It 
is true uva ursi contains a very large percentage of tannic 
acid, but the latter must differ somewhat in its properties 
from the ordinary tannic acid, or there must be another con- 
stituent co-active in the reaction. I am impelled to this belief 
by the fact that when spirit of nitrous ether is mixed with 
tannic acid, the volume of gas evolved is very insignificant ; 
there is a red color produced, due most probably to the 
formation of a small quantity of nitrogen tetr oxide, but 



PRESCRIPTION INCOMPATIBILITIES 51 

hardly ever is there sufficient gas to expel the cork. The 
ingredients should be mixed in a large graduate or mortar; 
ample time should be allowed for the evolution of gas to 
cease, and after the bottle is corked enough time should elapse 
before delivering it, to make sure that the cork will not come 
out (or it may be tied with a string). The nitrous ether 
is completely spoiled, decomposed, in this prescription, and 
might as well have been left out by the physician. 

72. Fluid Ext. Buchu 
Spt. Aetheris Nitrosi 

Spt. Jump. Corap aa 30.0 

Syr. Rub. Idaei 15.0 

Aquae 60.0 

A reaction similar to the one in the preceding prescription 
takes place in this, i. e., there is evolution of gas, liability to 
explosion, etc. The same remarks about dispensing apply 
to this one. 

73. Potass. Iodidi 3 ij 

Syr. Ferri Iodidi 3 ijss 

Aquae "% jss 

I prescribe this combination very frequently, and some- 
times I will find a precipitate and sometimes not. If chem- 
ically pure potassium iodide be used, no precipitation will 
take place. Commercial KI is crystallized from a solution of 
potash (which gives it better keeping qualities) and con- 
tains, besides, as an impurity, a small amount of potassium 
carbonate. It is the hydroxide (with the carbonate) which 
produces a precipitate of ferrous hydroxide. In cases where 
no precipitate is found, it is probably due to one of two 
causes; either it is filtered out, or the syrup of iodide of 
iron was not made properly, and contained an appreciable 
quantity of free iodine ; the latter combined with the KOH, 
and thus prevented precipitation. In no case was it referable 
to the employment of chemically pure KI, as none of the 
druggists kept this in stock ; it is prone to liberate iodine and 
become discolored. 



52 PRESCRIPTION INCOMPATIBILITIES 

74. Aeidi Phenylici 3 ij 

Collodii 3 vj 

S.: Apply with camel's-hair brush night and morning. 

When carbolic acid is added to collodion, a coagulated mass 
forms, which cannot be applied with a brush. Besides, the 
property of the collodion becomes changed ; i. e., the collodion 
becomes useless as such. The physician's attention should 
be called to these facts, and the suggestion made to him to 
employ creosote instead of phenol. Creosote forms a clear 
solution with collodion. 

Carbolic Acid Is Incompatible with Collodion: a Co- 
agulated Mass Is Formed. 

75. Hydrargyri Chlor. Corros gr. vj 

Aquae Calcis 5 iv 

Aquae Plumbi 

Aquae Destill aa J ii 

S. : Poison! For external use only. 

This prescription admirably serves to illustrate what dif- 
ferent results we may obtain in some instances by a different 
order of mixing the ingredients, and how absolutely neces- 
sary it is, therefore, to take note of the exact order observed. 
If the solution of corrosive sublimate be poured into the lime 
water, yellow mercuric oxide will be formed ; if the lime 
water be poured into the solution of the corrosive sublimate, 
brown mercuric oxychloride will precipitate. The subse- 
quent addition of the lead water to this mixture will not 
change the result, and the patient will receive a shake mix- 
ture with a yellow or brown precipitate. If, on the other 
hand, the mercuric chloride solution is added at once to 
the lead water, a milky white homogeneous mixture is ob- 
tained, which remains unchanged by the subsequent addi- 
tion of the lime water. As to the exact chemical composi- 
tion of this precipitate, my impression is that it is a basic 
acetate of mercury, together with some lead chloride ; it is 
also possible that a double compound of mercury and lead 



PRESCRIPTION INCOMPATIBILITIES 53 

is formed. For practical purposes it is sufficient to know 
that the reaction does not take place with the neutral lead 
acetate. 

I have also seen this prescription dispensed as a perfectly 
clear, colorless solution. On investigating the following cause 
was discovered: Some druggists invariably add to their 
liquor plumbi subacetatis a little acetic acid for the intended 
purpose of preventing its becoming turbid on exposure or on 
being mixed with plain water. That they thus destroy all 
their work and convert the basic acetate into a normal one 
does not enter their minds. At any rate, when the mercuric 
chlorid is mixed with such a lead water no precipitation 
will take place nor will there be any reaction on the addi- 
tion of the lime water. The mercuric chloride will remain 
unimpaired and unchanged; but we must not forget that 
instead of lead subacetate we have lead acetate, and in- 
stead of calcium hydroxide we have calcium acetate. 

76. Sol. Hydrarg. Perehlor. Sat 3 j 

Aquae Calcis 3 v 

Mucil. Acaciae 5 J 

Here is another example where the order of mixing the 
ingredients controls the results. If the solution of the cor- 
rosive sublimate is poured into the lime water, yellow mer- 
curic oxide is formed; if the lime water is added to the 
solution of the bichloride, the reddish-brown oxychloride of 
mercury precipitates. If the corrosive-sublimate solution is 
mixed with the mucilage of acacia and then with the lime 
water, precipitation will be prevented altogether or for sev- 
eral days at any rate. The mucilage of acacia must be the 
true U. S. P. mucilage and not one of those dark, almost 
black, sour-smelling products which pass for mucilage of 
acacia in some drug-stores. 

77. Sol. Kalii Arsenicosi 10.0 

Argenti Nitrici 0.5 

Syr. Sacchari 25.0 

Aquae Meuthae 125.0 



54 PRESCRIPTION INCOMPATIBILITIES 

This prescription presents a triple incompatibility. The 
potassium carbonate present in Fowler's solution will precip- 
itate the silver as silver carbonate ; another portion of the 
silver will combine with the arsenite, precipitating it as the 
bright-yellow silver arsenite; and lastly the silver nitrate 
is incompatible with the sugar of the syrup and with the 
peppermint water. As the prescription stands it should not 
be dispensed ; but it can be made dispensable. By acidifying 
the Fowler's solution two objects are gained: The potassium 
carbonate is neutralized, and thereby precipitation of the 
silver arsenite is prevented (the latter does not take place 
in an acid solution). When Fowler's solution is acidified for 
combination with alkaloidal salts, etc., hydrochloric acid is 
usually employed. In the present case HC1 cannot be used, 
as it would precipitate the entire amount of silver as silver 
chloride; the most eligible acid in this case is nitric acid. 
The simple syrup should be left out altogether; and instead 
of peppermint water distilled water should be used. The 
compound tincture of lavender of the arsenical solution would 
also tend to decompose the silver nitrate. As there are so 
many radical changes necessary, it is best to consult the 
physician. 

78. Tr. Strophanti 3 i 

Spirit. Mindereri 3 i y 

Tr. Ferri Chloridi 3 i 

Glycerini 5 j 

Aquae q.s. ad J viij 

S.: J ss three times a day. 
This prescription was received with a query as to what 
the brown precipitate was due to and whether it could be 
prevented. The cause of the precipitation is this: Solution 
of the ammonium acetate is frequently alkaline; that ^ 
it contains some ammonium carbonate which has not been 
neutralized. This later produces a precipitate of ferric 
oxide. To avoid this a little extra acetic acid should be 
added to the spirit of Mindererus (as the U. S. P. directs), 



PRESCRIPTION INCOMPATIBILITIES 55 

to make sure that it is acid, and then only mix it with the 
tincture of iron. When thus made a clear, transparent, 
bright-red solution is the result. The bright-red color is due 
to the ferric acetate formed, according to the following equa- 
tion: 

FeCls + 3NH4&H.O« = Fe(C*H.O»)i + 3NILC1. 

The Pharmacopeia directs Basham's mixture to be made 
fresh when wanted for use; and in examinations the ques- 
tion frequently occurs: "Is Basham's mixture a stable prep- 
aration?" and the candidate is expected to answer that it is 
unstable. Accepting the term "stable" in its ordinary inter- 
pretation, the writer wishes to take issue with the examiners, 
and say that, if properly made, Liquor Ferri et Ammonii 
Acetatis, U. S. P. IX, is quite a stable solution. He made 
observations on several samples, and in three or four weeks 
no trace of decomposition was discoverable. The explana- 
tion of the assertion that the solution in question is very 
unstable is perhaps to be found in the fact that Basham's 
mixture made according to the old pharmacopeias was quite 
unstable, as it contained no protective agent such as is called 
for in the present formula, i. e., glycerin. 

79. Liq. Potassi Arsenitis 3 ij 

Ferri Dialysati 5 ij 

Aquae Anisi J ij 

This is an example of double incompatibility. The potas- 
sium carbonate in the Fowler's solution will precipitate fer- 
ric carbonate, which is almost immediately converted into 
ferric hydroxide. This with the potassium arsenite forms 
a basic ferric arsenite which precipitates. It will be re- 
membered that freshly prepared ferric hydroxide is the offi- 
cial antidote for arsenical poisoning, because it combines 
with the arsenic preparations, forming insoluble arsenites 
and arsenates. It sometimes happens that no precipitation 
Jakes place. If this is the case, it may be assumed that the 



56 PRESCRIPTION INCOMPATIBILITIES 

clialyzed iron has not been properly made, i. e., that it con- 
tains free acid. The free acid neutralizes the alkali in Fow- 
ler's solution, forming potassium chloride, and preventing 
precipitation. Dialyzed iron, when properly and conscien- 
tiously made, is neutral. The way to make up this prescrip- 
tion is to neutralize the Fowler's solution with a few drops 
of hydrochloric acid (or to take Liquor Acidi Arsenosi in- 
stead), add it to the anise water and the mixture to the 
dialyzed iron. 

80. Pepsini Puri 3 ij 

Acidi Hydrochlor. Dil 3 ij 

Bism. et Ammon. Citratis . . . 3 iij 

Syrupi Aurantii J j 

Aquae Menthae ad 3 iv 

S.: 3 j t.i.d., in Vino Xerico. 

The existence of bismuth and ammonium citrate in the 
United States and British Pharmacopoeias is a good example 
of misplaced zeal and misdirected energy. It, as well as bis- 
muth citrate, should be dropped from the next revision. 
There is not a single disease of the gastro-intestinal canal 
where the insoluble salts of bismuth — the subnitrate and 
the subcarbonate — do not act better than this soluble salt. 
In many conditions — such as ulcer of the stomach, ulcera- 
tion and inflammation of the bowels — the bismuth subni- 
trate, subcarbonate, etc., act well just because of their insol- 
ubility; i. e., they form a protective coating to the mucous 
membrane, and thus prevent the acids from coming in direct 
contact with it, while there is not a single condition in which 
a soluble bismuth salt is indicated. Another important point 
is, that the subnitrate and subcarbonate, being insoluble, can 
be given in very large doses (some physicians give as much 
as two to four drams at a dose) without any danger of 
producing toxic effects. Even the supposed advantage of the 
salt in question — its solubility — is a very uncertain quantity ; 
i, e., it loses the ammonia rapidly, and the solubility becomes 



PRESCRIPTION INCOMPATIBILITIES 57 

impaired. Bismuth and ammonium citrate is soluble only 
in an alkaline or in a perfectly neutral solution. In this 
prescription the hydrochloric acid decomposes it, forming 
ammonium chloride and bismuth citrate precipitating. Grad- 
ually the bismuth citrate will also be changed by the HC1 
into bismuth chloride and oxychloride. 

The reactions may be expressed as follows: 

I. BiCaHsCMNIL) 3 C 6 H 5 Ot + 3HC1 = BiC«H.OT + 3NILC1 + 

HsCeELOT 
II. BiCelLOT + 3HC1 = BiCl 3 + tLCerLOr 
III. BiCl 3 + ILO = BiOCl + 2HCl 

The above prescription may be dispensed, but it is just 
as well to take the citrate of bismuth from the start as to 
take the double salt and have the citrate precipitated out. 

81. Solut. Fowleri 10.0 

Tr. Ferri Chloridi 20.0 

Glycerini 30.0 

Aquae 60.0 

S. : Cochlear parvum post prandium. 

One would think that the potassium carbonate in the Fow- 
ler's solution would precipitate the iron. This is not the 
case, however, because the free HC1 in the tincture neutralizes 
the potassium carbonate ; carbon dioxide is given off, which 
is seen by the active effervescence which takes place when 
the tincture and the liquor are mixed. The directions are: 
A teaspoonful — literally a small spoon — after dinner. (I 
would advise the readers, especially the young drug clerks, 
to pay attention to the directions in the presented prescrip- 
tions; they may thus learn many common Latin expressions.) 

82. Spir. Amnion. Arom J j 

Tr. Ferri Chlor 3 ij 

Quinin. Sulph 3 ss 

Tr. Digitalis 3 ij 

Glycerini 3 iss 

Aquae ad J viij 



58 PRESCRIPTION INCOMPATIBILITIES 

There are three kinds of incompatibility in this prescrip- 
tion, which the doctor insisted on having dispensed just as 
written. The tincture of iron does not contain enough hydro- 
chloric acid to neutralize all the ammonia water and ammo- 
nium carbonate present in the aromatic spirit. There will 
consequently be a precipitate of ferric hydroxide. The sec- 
ond thing the spirit will do, is to precipitate the quinine, 
which would otherwise have been readily dissolved by the 
tincture of iron (due to its containing free HC1) ; the third 
point is the tannin of the digitalis will yield a greenish-black 
color with the iron. As to dispensing the prescription, I will 
repeat : As long as there is no dangerous poison in the mix- 
ture and the doctor wants to have it that way, let him have 
it. A fourth point of incompatibility might be mentioned: 
The separation of the oils from the aromatic spirit by the 
water; but this is of little importance in comparison with 
the other difficulties. 

83. Fern Pyrophosphatis 3 i j 

Acidi Phosphorici Dil 3 iij 

Syr. Rub. Idaei 5 j 

Aquae 3 iv 

Practically everything said in regard to soluble ferric 
phosphate (see prescription 111) is applicable to ferric 
pyrophosphate, as the latter is, like the phosphate, made solu- 
ble by the aid of sodium citrate. The phosphoric acid will 
decompose the soluble ferric pyrophosphate and cause a pre- 
cipitate. 

84. Potassii Chloratis 3 j 

Acidi Tannici 5 ss 

?S.: 3 j in cup of hot water, for a gargle. 

I felt almost like apologizing for putting down this pre- 
scription, it is so old and so well known. But I suddenly rec- 
ollected the accident in Greenwich street, where a drug clerk 
blew up half the store and nearly lost his life from the 
injudicious handling of potassium chlorate and sodium saU- 



PRESCRIPTION INCOMPATIBILITIES 59 

cylate, and then I saw that no apology was necessary. It is 
just those easy, well-known things that need be constantly 
kept in mind, constantly referred to. Potassium chlorate is 
a great oxidizing agent. An oxidizing agent is a substance 
which readily gives up its oxygen to other compounds. To 
the oxidizing agents belong the chlorates, nitrates, perman- 
ganates, chromates, etc. Oxidizable substances are such as 
readily combine with oxygen. To the easily oxidizable sub- 
stances belong sulphur, phosphorus and most organic sub- 
stances. If the potassium chlorate were rubbed rather vig- 
orously with the tannic acid in a mortar, an explosion would 
almost surely result. The right way is to powder the potas- 
sium chlorate separately (and even this must be done gently, 
because even if rubbed violently by itself an explosion is 
apt to result) and mix lightly with the tannic acid on a sheet 
of paper by the aid of a horn spatula. Instruct the patient 
to be careful. 

85. Potass. Permangan 3 ss 

Acidi Tannici 3 ij 

Alum, et Potass. Sulph ^ iv 

Acidi Boriei J xij 

M. et ft. pulvis secundum artem. 

S. : J ss in 4 qts. of hot water, as a douche every morn- 
ing and night. 

The remarks on the previous prescription apply also to 
this. The permanganate should be first powdered carefully 
(it need not be in a fine powder) by itself, then mixed with 
the boric acid, alum and lastly with the tannic acid. It 
may be remarked that the physician might as well have left 
out the permanganate, because when the solution is made it 
is reduced to a manganate by the tannic acid. 

86. Acidi Picrici 3 j 

Cocainae Mur 3 ss 

Aquae j 

S. : Apply on lint every hour. 



60 PRESCRIPTION INCOMPATIBILITIES 

This is a somewhat modern prescription. It was written 
by a well-known physician, who used to be assistant to the 
Chair of Materia Medica in one of our colleges. Picric acid 
has been recommended as an excellent remedy for burns. 
Wishing to obviate any possible burning sensation from the 
picric acid, the physician orders some cocaine with it; but 
in doing this he loses sight of the fact that picric acid is an 
excellent precipitant of almost all alkaloids. When a solu- 
tion of picric acid is added to a solution of cocaine hydro- 
chloride, the mixture becomes at once turbid, and soon the 
crystals begin to separate out. There can be no two opinions 
as to what course is to be pursued in the present case ; the 
cocaine is to be left out. Not only is it useless, because pre- 
cipitated in an insoluble condition, but if applied in that 
insoluble form it would do mischief by irritating the tender, 
recently burned surface. Of course, the physician is to be 
informed of the facts in the case. 

87. Sodii Salicyl 15.0 

Acidi Citrici 5.0 

Syr. Rub. Idaei 30.0 

Aquae 150.0 

Ft. solutio. S.: j ss t.i.d. p.c. 

This is another one of those prescriptions which vividly 
recall to my memory the good old junior days some thirty 
years ago. One busy afternoon we received the above pre- 
scription. The proprietor sent in a very polite note to the 
physician, telling him that he was no doubt aware of the 
fact, but it probably had slipped his mind, that citric acid 
would decompose the sodium salicylate, with the consequent 
precipitation of the salicylic acid; whether he would not or- 
der to leave out the citric acid, or give an equivalent amount 
of potassium citrate additionally. The physician made no 
reply, but appeared personally after a short while. "You 
must be very peculiar in making up prescriptions ; I made 
up that same prescription a dozen times at X's drug store, 



PRESCRIPTION INCOMPATIBILITIES 61 

and they never made any remarks; I always saw that the 
patients had a perfectly clear solution." Being of course 
absolutely certain of our being in the right, we told him that 
if X obtained a clear solution there was no sodium salicylate 
in his mixture, and we advised him to take the prescription 
to X 's drug store, go behind the counter and watch the clerk 
prepare it. He did. The clerk mixed all the ingredients as 
prescribed, and then filtered the mixture. That physician 
has since then had a good deal more respect for us than he 
did for X. The reaction is simple : 

SNadlLOa + H»C.H.Ot = NaiOH.OT + 3HCtH 5 3 . 

88. Potassii Permang 1.5 

Morph. Sulph 0.25 

Ext. Liquir q.s. ut fiat massa 

in pilulas No. xxiv dividenda. 

As explained in a previous prescription (No. 52), potas- 
sium permanganate must not be brought in contact with or- 
ganic matter, as it becomes decomposed. In the present in- 
stance there will be a double reaction which will make the 
pills entirely worthless. The potassium permanganate be- 
comes reduced by the morphine and. liquorice to potassium 
manganate and manganese dioxide; the morphine becomes 
oxidized, and has no longer the properties of morphine. The 
physician should be apprised of the facts in the case. 

89. Morphin. Sulph grn. ij 

Spt. Aether. Nitrosi 5 ss 

Fl. Ext. Bellad min. xij 

Aquae ad J ij 

S.: 3 j pro re nata. 

Morphine with sweet spirit of niter produces a yellow 
solution, due to the oxidation of the morphine by the nitrous 
compounds present in the spirit. The prescription may be 
dispensed, but I would not be astonished if I got little of the 
anodyne effects of the morphine, and I think the physician 



62 PRESCRIPTION INCOMPATIBILITIES 

would be thankful if his attention were called to the incom- 
patibility. 

90. . Morph. Sulph gr. ij 

Liquor. Potassii Hydrox 3 ij 

Aquae Chloroformi 

Fluidext. Tritici 

Glycerini aa I j 

"This prescription is incompatible, because the liquor po- 
tassii hydroxidi, being an alkali, will precipitate the mor- 
phine." Give this prescription at an examination, and al- 
most every one of those answering it at all would answer it 
in words indicated above. But this prescription is not in- 
compatible. True, morphine salts are precipitated by po- 
tassium and sodium hydroxides, but the precipitates are re- 
dissolved by an excess of the alkali. In this case there is 
more than sufficient solution of potass, hydroxide to redis- 
solve the precipitated morphine and to keep it in solution. 
If, instead of 2 dr., there were prescribed only a few drops 
of liquor potassae, the prescription would be incompatible 
and could not safely be dispensed. 

91. Strych. Sulph gr. j 

Liquor Potassii Hydros 3 ij 

Aquae Chloroformi 

Ext. Tritici Fl. 

Glycerini aa 5 j 

This prescription is by the same physician who wrote the 
previous one. That one was for the acute irritable stage of 
cystitis; after that stage had passed, he prescribed a tonic 
instead of a sedative. While the first prescription was dis- 
pensed without hesitation, it was deemed obligatory to notify 
the physician that it would not be quite safe to dispense this 
second one ; and he was very thankful for the information, as 
the really good physicians always are, and ordered the strych- 
nine in tablet form. The reason of the incompatibility is that 



PRESCRIPTION INCOMPATIBILITIES 63 

strychnine (alkaloidal) is precipitated and is not redissolved 
by excess of alkali. 

92. Liq. Plumbi Subaeetatis 3 ij 

Solut. Ac. Boriei Satur 5 V J 

S. : Apply externally. 

A milky white precipitate results when the two solutions 
are mixed, due to the formation of lead borate. This chem- 
ical is formed only in an alkaline medium. Its formation 
can therefore be prevented in two ways: either by adding a 
few drops of acetic acid to the liquor plumbi subaeetatis, to 
neutralize its alkalinity; or by taking an equivalent quan- 
tity of lead acetate (in this case, about half a dram). Either 
expedient is permissible ; a perfectly clear solution will re- 
sult in each case. 

Lead Salts Are Incompatible with Boric Acid in an 
Alkaline Medium. 

93. Plumbi Aeetatis 0.3 

Sodii Biboratis 0.5 

Aquae Rosae 40.0 

S.: Drop 3 drops into each eye every 4 hours. 

The same reaction will take place here as in the previous 
prescription, but the alkalinity is here due not to the lead 
salt but to the borax. The mixture should not be dispensed 
in this condition, especially as it is to be used with an eye 
dropper. The best thing to do is to use an equivalent quan- 
tity of boric acid; the solution will then be perfectly clear. 
Glycerin will also prevent precipitation. (For a full discus- 
sion of this, see the next prescription.) There is something 
else wrong with this prescription, more important even than 
the incompatibility; namely, the employment of lead in the 
eye. Salts of lead should never be employed on the eyeball, 
a% several cases of corneal opacities have been reported from 
their use, due to the deposition of lead. 

Lead Salts Are Incompatible with Borax in Solution: 
Lead Borate Precipitates. 



64 PRESCRIPTION INCOMPATIBILITIES 

94. Plumbi Acetatis 5 ss 

Sodii Boratis 3 j 

Glyeerini § ss 

Aquae q.s. ad J iv 

This prescription differs from the preceding one in that 
it contains an additional ingredient, glycerin, which makes 
"all the difference in the world" in this case. The combina- 
tion is a good illustration of what actual aid chemical knowl- 
edge is to us in preventing and correcting incompatibilities. 
If the borax be mixed with the lead acetate, a precipitate will 
occur, as explained in the previous two prescriptions ; but the 
precipitate dissolves on the addition of the glycerin. If the 
glycerin be added to a solution of the lead acetate and then 
mixed with the borax, a precipitate will also form which will 
redissolve on shaking, provided there be sufficient glycerin 
present. But if the glycerin be added to the dissolved borax 
and then mixed with the sugar of lead, no precipitation will 
take place. What is the cause of this? 

To understand this fully, we must examine into the chem- 
istry of borax. Borax is not the normal borate of sodium, of 
the formula Na 3 B0 3 . Its formula is Na 2 B 4 7 , and chemically 
it is sodium penta-meta-tetra-borate, or it is penta-meta-tetra- 
boric acid, in which the two hydrogens have been replaced 
by two atoms of sodium. The word "meta" means change. 
A meta acid is an acid resulting by the subtraction of the 
elements of one or more molecules of water from the regular 
or ortho acid. For instance, phosphoric acid is H 3 P0 4 ; sub- 
tract one H 2 and meta-phosphoric acid — HP0 3 — is left. 
Boric acid is H 3 B0 3 . Subtract one H 2 0, and meta-boric acid 
is obtained. Now, penta-meta-tetra-boric acid means boric 
acid, which results by subtracting 5H 2 from 4 molecules 
of boric acid. 4XH 3 B0 3 =H 12 B 4 12 ; and H 12 B 4 12 — H 10 O 5 
(=5XH 2 0)=H 2 B 4 7 . Replace the two hydrogens by s*o- 
dium, and you get the formula of the official borax — Na 2 B 4 7 . 
When this borax is mixed with glycerin, it is decomposed 
into sodium meta-borate and boric acid, and is no longer 



PRESCRIPTION INCOMPATIBILITIES 65 

alkaline. This rather remarkable reaction can be expressed 
by the following two equations: 

1. Na 2 B,07 + C 3 H 5 (OH) 3 = 2NaB0 2 + H3BO3 + GVEsBOa 
Sodium Glycerin Sodium Boric Glyceryl borate 
Borate Metaborate Acid 

2. C3ILBO3 + 3ILO = C 3 H 5 (OH) 3 + H 3 B0s 
Glyceryl Water Glycerin Boric acid 
Borate 

As is seen, glyceryl borate is one of the intermediate prod- 
ucts, but is redecomposed by the water into glycerin and 
boric acid. As the solution is now acid, lead borate is not 
formed. 

95. Zinci Sulph grn. xvj 

Sodii Boratis grn. xxx 

Glyeerini 5 ss 

Aquae ad J iv 

S. : Use as an injection. 

Zinc Sulphate and Borax Yield a Precipitate of Zinc 
Borate. 

But in the presence of glycerin, boric acid is formed, and 
no precipitate results. (See the remarks on prescription No. 
93 and prescription No. 94.) 

96. Aconitinae Cryst 0.06 

Atropinae Sulph 0.12 

01. Olivae 8.00 

S.: Apply to neuralgic spots. 

The alkaloidal salts are not as a rule soluble in the fixed 
oils, while the uncombined alkaloids are. Atropine should 
be used instead of its sulphate. 

97. Aeidi Salicylici 3 ij 

Aquae Destill 5 i y 

Fiat Solutio. S. : Apply externally. 

That many physicians do not know the solubilities of chem- 
icals is a well-known fact. It is perhaps pardonable. Never- 
theless, some prescriptions are simply exasperating to the 



66 PRESCRIPTION INCOMPATIBILITIES 

druggist. Here the physician expects the pharmacist to ac- 
complish the impossible; to dissolve a substance in 4 fl. ozs. 
of water, when it would require fully seven and a half pints, 
or 120 fl. ozs., to effect solution! Salicylic acid is soluble in 
460 parts of water ; that is, about 1 grn. in 1 oz. As there are 
120 grn., it would require 120 fl. ozs. Boiling the water would 
only make matters worse, because while the salicylic acid 
would be dissolved temporarily, it would separate out in 
large needle-shaped crystals as the solution became cold. 
The physician should be informed of the trouble. 

98. Ac. Borici 3 ij 

Aquae Destill 3 i y 

Fiat Collyrium. S. : Use with eye-dropper. 
Only about 70 grn. would dissolve in 4 fl. ozs. of water, 
and this is all that should be used ; i. e., a saturated solution 
should be dispensed. The physician need not be consulted. 
The addition of glycerin to increase the solubility of the 
boric acid is not advisable, in view of the fact that the solu- 
tion is to be used for the eyes. Glycerin, even when diluted, 
sometimes proves irritating. 

99. Mentholi grn. x 

Thymoli grn. iij 

Eucalyptoli min. v 

Cocainae Hydrochlor grn. x 

Petrolati Liquidi "% ij 

S. : Use with spray night and morning. 
This is a very common prescription. The first three in- 
gredients dissolve without any difficulty in the liquid petro- 
latum, but the cocaine hydrochloride is absolutely insoluble 
therein. Cocaine alkaloid is soluble, and that should be used. 

100. Morphin. Sulph grn. xij 

Ac. Oleici 3 ss 

For external use only. 

The alkaloidal salts are not soluble in oleic acid; the free 
alkaloids are. Morphine should be used instead of morphine 



PRESCRIPTION INCOMPATIBILITIES 67 

sulphate. If morphine is not at hand — and it seldom is in 
the average drug store — it can easily be prepared as follows : 
Make an aqueous solution of morphine sulphate, add ammo- 
nia water until the precipitate ceases to form, collect the pre- 
cipitate (which is free morphine) and dry it between filter 
paper. Dissolve the alkaloid in the oleic acid, using very 
gentle heat if necessary. 

101. Strontii Bromidi 15.0 

Divide into powd. No. xxx. 

There are 10 chances to 1 that if the above prescription is 
dispensed as directed, that is, in powder form, the patient 
will have' no powders to take ; he will only find wet pieces of 
paper. Wax paper or parchment paper will not prevent the 
deliquescence altogether. Strontium bromide is one of the 
most deliquescent salts we have, and the druggist should re- 
fuse to dispense it in powder form. The physician should 
be informed; he will probably order the prescribed quan- 
tity to be dissolved in 120 c. c. of water ; the solution to be 
taken in teaspoonful doses. (Some varieties of strontium 
bromide are but slightly deliquescent.) 

102. Strontii Bromidi 5 ij 

Strontii Iodidi 5 j 

Morphin. Sulph grn. iij 

Aquae ad 5 ij 

This prescription presents a double incompatibility. Not 
only is the morphine liable to be precipitated by the bromide 
and iodide of strontium (as it is by any iodide or bromide) 
but the sulphate radicle in the morphine will precipitate a 
part of the strontium as a sulphate. 

103. Strontii Bromidi 3 i j 

Potassii Aeetatis 3 j 

Lithii Citratis 3 ij 

Tr. Digitalis 3 ij 

Aquae ad J i j 

This prescription was recently received from a druggist, 



68 PRESCRIPTION INCOMPATIBILITIES 

who wrote that he made up the mixture in different ways, 
but each time got an abundant precipitate. ' He was aston- 
ished that a chemical reaction should take place in such an 
apparently simple prescription, and wanted to know what 
the reaction was. The reaction is a simple one. The lithium 
citrate decomposes the strontium bromide, with the forma- 
tion of strontium citrate (which, being insoluble, precipi- 
tates) and lithium bromide. 

3SrBr 2 + 2LisC6H 5 07 = Sr 3 (C«H 5 7 ) 2 + 6LiBr. 

Strontium Salts Should Not Be Prescribed with Ci- 
trates in Solution. 

104. Strontii Bromidi 3 ij 

Natrii Bicarbon 3 iss 

Aquae 5 i y 

The strontium bromide is decomposed and precipitates as 
a carbonate; but in addition to this, there is quite an active 
evolution of carbon dioxide, so that if put at once in a bottle 
the cork may be blown out. The reaction is as follows : 

SrBr 2 + 2NaHC0 3 = SrC0 3 + 2NaBr + ILO + C0 2 . 

Soluble Strontium Salts Should Not Be Prescribed in 
Solution with Soluble Carbonates or Bicarbonates. 

105. Aluminis grn. xl 

Plumbi Acetatis grn. xx 

Aquae Destill , 3 iv 

S.: Inject two syringefuls 3 times a day. 
The official alum is a double sulphate of aluminum and 
potassium or aluminum and ammonium, and with lead acetate 
forms lead sulphate, which precipitates. In this case, the 
prescription being intended as a gonorrheal injection, the 
precipitate should not be filtered out unless the physician so 
orders. The reaction which takes place is as follows : 

KA1 ( SO*) rf 2Pb ( C 2 H 3 2 ) 2=A1 ( C 2 H 3 2 ) 3 +KC 2 H 3 2 +2PbS04 
Alum Lead Acetate Alum. Acetate Potass. Lead 

Acetate Sulph. 






PRESCRIPTION INCOMPATIBILITIES 69 

It may not be out of place to note here that this solution 
of aluminum acetate is practically the well known "Solutio 
Burowii" which at one time was very popular on the con- 
tinent, but later came into disuse; lately aluminum acetate 
is again coming into extensive use. 

106. Aluminis grn. v 

Plumbi Acetatis grn. iij 

Aquae Dest 3 vj 

S. : Three drops into each eye. 

In this case, the precipitate should be carefully filtered out, 
as the insoluble lead sulphate would cause great irritation 
to the eye. 

107. Aluminis 5 xr7 

Plumbi Acetatis 5 vj 

M. ft. pulvis. Detur ad scatulam. 
S. : Tablespoonful in a quart of water, as a douche. 

When alum and lead acetate are rubbed together in a 
mortar a soft mass is obtained, due to chemical reaction and 
the consequent liberation of the very large amount of water 
of crystallization. This can be prevented by using the pro- 
portionate amount of the dried salts, or by mixing the salts 
lightly, without trituration. But this is not the point I 
wish to bring out. My contention is that the prescription is 
a bad one to dispense. The reason may appear a trivial one 
but it is to be counted with nevertheless. The insoluble lead 
sulphate clogs up the little holes of the vaginal tube and 
makes the douching very inconvenient. The doctor should 
be consulted; perhaps he would agree to use zinc acetate 
instead. Several instances have come to my notice, where 
ladies refused to use or complained about the above powder. 

The above three prescriptions well illustrate how different 
directions at the end of the same prescription may differently 
determine the conduct of the pharmacist in dispensing that 
prescription. 



70 PRESCRIPTION INCOMPATIBILITIES 

108. Zinei Sulphatis . grn. iij 

Sodii Boratis grn. x 

Aquae Rosae 3 j 

M. ft. Collyrium. 

A precipitate of zinc borate (and some zinc hydrate) re- 
sults. The remarks concerning prescription No. 93 apply to 
this one as well. (See also prescription 95.) 

109. Iodi Resublim 3 j 

Adipis Lanae J j 

To put the iodine in a mortar, make an attempt at powder- 
ing it, and then rub it up with the woolfat, as I saw a drug- 
gist do it, shows the acme of incompetence. When solids are 
to be incorporated with an ointment base, they should be 
either in the form of a fine, impalpable powder, or a soft, 
smooth, homogeneous mass; or, when possible, in solution. 
It is next to impossible to reduce iodine to an impalpable 
powder. A little potassium iodide and water should be added, 
so as to dissolve the iodine (in this case about 15 grains of 
potassium iodide and % to 1 dram of water) ; then only is 
it to be gradually incorporated with the woolfat. 

110. Potassii Iodidi 8.0 

Adipis 60.0 

M. ft. ung. 
Here again, if the pharmacist is up to the mark, he will 
first dissolve the potassium iodide in hot water (about 1% 
drams), and he will add a little sodium thiosulphate, to pre- 
vent the liberation of iodine and the consequent discolora- 
tion of the ointment. He will thus avoid the possible bring- 
ing back of the salve in a few days with the tale that "it 
has turned brown and mamma is afraid to use it; wouldn't 
you please make up another jar?" 

111. Ferri Phosphatis 3 iss 

Acidi Phosphor. Dil 3 ij 

Syr. Simpl 3 ss 

Aquae ad J iij 



PRESCRIPTION INCOMPATIBILITIES 71 

This prescription has become a standing nuisance to every 
one who has to do with prescription incompatibilities. It is 
one of the most frequent prescriptions in my collection, and 
it can be found in almost any volume of every pharmaceutical 
journal. The reason of it lies perhaps in the confusion which 
exists in the average druggist's and physician's minds as 
to the difference between the true chemical and the official 
ferric phosphate. The former — Fe 3 (P0 4 ) 2 — is a whitish pow- 
der, very slightly soluble in water but soluble in solutions 
of the alkaline citrates and in strongly acid solutions. The 
official phosphate is a combination of ferric phosphate and 
sodium citrate, and bears the title (in its synonym) "soluble 
ferric phosphate" to distinguish it from the true chemical, 
insoluble phosphate. On adding phosphoric acid, the sodium 
citrate, which acts as a solvent for the iron salt, is decom- 
posed, a little sodium phosphate and citric acid being formed. 
As those do not act any more as a solvent for the ferric 
phosphate, the latter precipitates. To leave out the phos- 
phoric acid would be inadmissible, as it is an important 
medicinal ingredient. If diluted meta-phosphoric acid 
(HP0 3 , also called "glacial" phosphoric acid) be used, no 
precipitation will occur. For my part, I see no objection to 
dispensing the above mixture as written, with a shake label. 

112. Ferri Phosphatis Solubilis 5 iss 

Acidi Pkosphorici 3 ij 

Syr. Simpl 3 ss 

Aquae Foeniculi ad J iij 

In this prescription the physician ordered phosphoric acid, 
concentrated, and not the diluted. No precipitation will 
take place, because as stated above ferric phosphate is soluble 
in strongly acid solutions. It may also be noticed here, that 
if the amount of the acid be very small in proportion to the 
amount of ferric phosphate used, no precipitate will form, 
as the acid is either too dilute to decompose the sodium citrate 
at all, or only a very insignificant proportion of the latter is 



72 PRESCRIPTION INCOMPATIBILITIES 

decomposed, the balance still being sufficient to act as a 
solvent. In the pharmaceutical journals where the above 
prescriptions are criticized, the statement is generally made 
that soluble ferric phosphate and ortho-phosphoric acid are 
incompatible; but I never found any reference to the fact 
that the proportion of phosphoric acid used made quite some 
difference. To the question: Why is a solution of soluble 
ferric phosphate of a nice green color, while a solution of 
ferric phosphate, to which a sufficient quantity of acid has 
been added to redissolve the formed precipitate, is perfectly 
colorless? The following explanation may be satisfactory: 
The soluble ferric phosphate is not a simple mixture, but 
more or less of a chemical combination of two salts. It is 
a kind of double-salt and the best name for it, in my opinion, 
would be "ferri-sodio-phospho-citrate." It is this double- 
salt that is of a green color. On adding phosphoric acid it 
is decomposed, ferric phosphate (true), sodium phosphate, 
and citric acid being formed. None of these compounds 
possesses a green color. 

113. Ext. Hyoseyami 3 j 

Ac. Tannici 3 ss 

Adipis I j 

The extract is to be rubbed up with a little diluted alcohol 
and incorporated with about half an ounce of the lard; the 
tannic acid is incorporated with the other half, and the two 
salves mixed. The tannic acid should not be brought in im- 
mediate contact and rubbed with the extract, as the alkaloids 
of the hyoscyamus — hyoscine and hyoscyamine — are thus 
more likely to become insoluble tannates. 

114. Acidi Carbol min. v 

Glycer. Boroglycerini J j 

Aquae 5 ij 

S. : Apply to the throat with a cotton swab. 

Glycerite of boroglycerin contains a very large amount of 
boric acid in solution — 31 per cent, by weight. It contains 



PRESCRIPTION INCOMPATIBILITIES 73 

it in the form of a true chemical compound, glyceryl borate or 
boroglycerin, C 3 H 5 B0 3 . This will furnish an answer to the 
question, so often asked, why the Pharmacopoeia did not name 
this particular glycerite "Glyceritum Ac. Borici," the same 
as "Glycer. Ac. Carbolici," or "Glycer. Ac. Tannici." In 
the last two the acids are simply dissolved in the glycerin, 
while in borogtycerin the boric acid is chemically combined 
with a portion of the glycerin ; and the glycerite is a solution 
of this chemical compound in glycerin. Now, boroglycerin 
is decomposed in the presence of water, as shown by the fol- 
lowing equation (see also No. 94) : 

C3H5BO3 + 3H2O = C 3 H 5 (OH)3 + H3BO3 
Boro- Water Glycerin Boric Acid 

glycerin 

That is, glycerin and boric acid are reformed. 

As boric acid requires 25 parts of water for solution, there 
is not enough of the latter to keep all dissolved, so that part 
of the acid precipitates out. The application to the throat 
would thus lose considerably in effectiveness. If instead of 
the water we use glycerin, wholly or in part, no precipitation 
will take place ; and thj° is the method to be pursued in dis- 
pensing the prescription. It is well to note that the pre- 
cipitation will take place only if the boroglyceride is fully 
up to the standard and has been made up with official glyc- 
erin; a weak preparation will show no change when mixed 
with water. 

115. Tr. Nucis Vomicae 3 iij 

Strychninae Sulph % gr. 

Sol. Fowleri 3 iij 

Syr. Ferri Iodidi 3 vi 

Elixir Calisayae ad J iij 

Those who think that it is useless to worry with prescrip- 
tion incompatibilities would change their minds if they had 
an opportunity to work in a real pharmacy, say where 100 
to 300 prescriptions are made up daily. They would then 



74 PRESCRIPTION INCOMPATIBILITIES 

be convinced that the subject of prescription incompatibili- 
ties is more important — to the druggist — than botany, physics, 
physiology or toxicology. The above prescription, written 
by an eminent physician, is a bad one. The Fowler's solu- 
tion precipitates the strychnine both from the nux vomica 
and from the sulphate ; it also precipitates ferrous carbonate 
from the syrup ; besides, the iron forms an inky mixture with 
the tannin (cincho-tannic acid) of the calisaya and — to finish 
up — some ferrous arsenite is likely to be formed. To dis- 
pense it as written is absolutely inadmissible. A slight ma- 
nipulation would improve matters a good deal. Add very 
carefully some diluted hydrochloric acid just to neutralize 
the alkalinity of the Fowler's solution, or to make it very 
faintly acid. This will obviate the precipitation of the 
strychnine and of the ferrous carbonate. But we must be 
careful not to add too much acid as otherwise the ferrous 
iodide may be decomposed, with the liberation of free iodine. 
Leaving out the Fowler's solution altogether (with the physi- 
cian's permission) will also obviate most of the difficulties. 

116. Ichthyol 8.0 

Ac. Hydrochlor. Dil 12.0 

Aquae Amygd. Amar 10.0 

S. : Guttas quindecim ter in die, in paululo aquae, post 
cibos. 

This prescription is absolutely incompatible. A dark resin- 
ous precipitate collects on the sides and bottom of the bot- 
tle, and the entire mixture becomes worthless; even the bot- 
tle has to be thrown away. Ichthyol, without any further 
specification, is ammonium sulpho-ichthyolate or ichthyol 
sulphonate. Mineral acids decompose it, the acid radical 
combining with the ammonium and the sulpho-ichthyolic (or 
ichthyol-sulphonic) acid precipitating. The physician should 
be notified of the facts. The direction reads: Fifteen drops 
three times a day in a little water after meals. 



PRESCRIPTION INCOMPATIBILITIES 75 

117. Ichthyol 3 iij 

Tr. Nuc. Vom 3 ij 

Tr. Capsici 3 iv 

Tr. Cannab. Ind 3 ij 

Tr. Cinch. Comp ad J iij 

S.: Teaspoonful before and after the principal meals. 
Ichthyol being insoluble in alcohol, a precipitate will grad- 
ually form ; but as the ichthyol is not decomposed and its vir- 
tues are not impaired, the mixture may be dispensed with 
a "shake" label, and with instructions to keep the bottle 
on the side. If the bottle is stood up and is not shaken fre- 
quently, the ichthyol will ollect in a resinous mass at the 
bottom, which it will be impossible to detach and distribute 
throughout the bottle. 

118. Ichthyol I iss 

Hydrargyri Chlor. Corros gr. viij 

Potassi Iodidi 3 ij 

Tr. Cardam. Comp 5 ss 

Aquae Menthae Pip ad J vj 

S. : Teaspoonful 4 times a day. Reduce to half -teaspoon 3 
times a day if the stomach gets upset. 

Ichthyol being prescribed in such a great variety of dis- 
orders, it is no wonder that it is occasionally prescribed in 
combination with drugs with which it is incompatible. 

Recently the above mixture was sent to me by a druggist, 
asking whether I could not do anything to restore or to im- 
prove it ; it being quite an expensive prescription, he did not 
feel like throwing it out, but of course he could not send it 
out the way it was. No, he could not, indeed! It was a 
very curious looking mixture. In a brownish transparent 
liquid there floated numerous pieces that looked like black 
pitch. Some of the pieces were quite large, so that they 
could not get out of the bottle. I told him that there was 
no way of "restoring" the prescription, nor was there any 
way of making it up properly from the start, except, perhaps, 
by making an emulsion. But that if he did not feel like 



76 PRESCRIPTION INCOMPATIBILITIES 

throwing away the mixture, he should break the bottle, filter 
the mixture, collect the precipitate on the filter, and dispense 
it in 48 capsules (it was just the right consistency to be 
divided, without any extraneous addition), and instruct the 
patient to take for each dose a teaspoonful of the filtered 
liquid and one capsule ; that he should first notify the doctor, 
however. The physician gave his sanction, and the druggist 
acted as here suggested. The precipitate was due to the 
formation of potassic and mercuric ichthyol-sulphonates, 
which are much less soluble in water than the ammonium 
ichthyol-sulphonate. Mercuric chloride by itself, in the doses 
in which it is usually given, may be prescribed with ichthyol, 
because, in the first place, the precipitate is slow in forma- 
tion, and, secondly, because it is not of a resinous character 
(sticking to the walls of the bottle), but may be easily dis- 
tributed throughout the contents by shaking. 

119. Ammon. Sulpho-ichthyol 3 ij 

Strychninae Sulph gr. j 

Quininae Sulph gr. xxx 

Syr. Rub. Idaei J j 

01. Caryophyllor gtt. iv 

Aquae ad J iv 

S. : 3 j ter in die, p.c. 
This would be a dangerous prescription to dispense. Ich- 
thyol is incompatible with almost all alkaloids, because the 
ichthyol-sulphonic acid combines with them and precipitates 
them as difficultly soluble ichthyol-sulphonates. In this case 
both the strychnine and the quinine would be precipitated 
in the form of a sticky resinous mass; and it is not hard to 
imagine the patient getting the whole grain of strychnine at 
one dose. The prescription should not be dispensed. 

120. Ichthyol 6.0 

Cocainae Hydrochl 0.6 

Aquae Dest 200.0 

Inject 3 times a day, after urinating. 
In order to alleviate the burning sometimes caused by a 



PRESCRIPTION INCOMPATIBILITIES 77 

3 per cent, ichthyol injection in very acute gonorrheas, the 
physician orders some cocaine with it. But, alas! the co- 
caine will do here no good, because, being an alkaloid (see 
above) it will be precipitated as cocaine sulphoichthyolate. 
The cocaine should be left out and the physician informed of 
the facts. 

From the Preceding Five Prescriptions It Is Seen That 
Ichthyol Is Incompatible with (1) Acids, (2) Alcohol, 
(3) Mercuric Chloride and Potassium Iodide and (4) Al- 
kaloidal Salts. 

121. Sol. Fowleri 3 ij 

Hydrargyri Bichloridi gr. iij 

Aquae 3 iij 

S. : 3 i t.i.d., p.e. in water. 

This prescription is absolutely incompatible. In the way 
it is written, it will of course not be dispensed by any one, not 
even by the merest junior tyro. A variety of reactions will 
take place, depending upon the relative proportion of the 
ingredients and upon the order of mixing them. As is well 
known, Fowler's solution contains free potassium carbonate 
(potassium bicarbonate is taken; but, as explained in pre- 
scription No. 63, any bicarbonate in solution, when heated to 
boiling, becomes converted into a carbonate) ; this converts 
the bichloride into mercuric carbonate, mercuric oxide, and 
mercuric oxychloride; these mercuric compounds undergo 
further changes, which end in the separation of a great deal 
of the mercury in the metallic state. But this is not all. The 
mercury displaces the potassium in the potassium arsenite, 
forming mercuric arsenite and possibly also arsenate. 

By adding some hydrochloric acid to the Fowler 's solution, 
so as completely to neutralize the potassium carbonate, most 
of the trouble will be obviated; i. e., there will be no pre- 
cipitate of mercuric carbonate or oxide, etc. ; in fact, the 
mixture will at first be perfectly clear and transparent, but 
gradually there forms a slight precipitate (of mercuric arse- 



78 PRESCRIPTION INCOMPATIBILITIES 

nite?). The prescription may be dispensed with a "shake 
well" label. 

122. Ac. Salicyl. (from Wintergreen) 3 ij 

Morphia Sulph gr. iii 

Syr. Aurantii Cortex J i 

Aquae q. s ad J iij 

Sig. 3 i every three hours. 

The above prescription which I reproduce verbatim was 
received by me from a druggist in Portland, Oregon. The 
druggist writes as follows : "I received this prescription last 
evening. I tried hot water, hot glycerin, alcohol, all of which 
readily dissolved the acid, but in each instance on cooling 
or adding water or syrup the acid separated and had a con- 
sistency not unlike very sour milk. I have referred this pre- 
scription to other druggists but have received no informa- 
tion. The physician informed me that he had this com- 
pounded at another pharmacist's and secured a clear mix- 
ture. I have consulted all of the authorities at hand but 
none seem to cover the case. I am of the opinion that it may 
be myself and not the ^ that is at fault. Kindly inform 
me." 

There is no way of dispensing this prescription as a clear 
solution. There is no way of dissolving 2 drams of salicylic 
acid in 3 ozs. of an aqueous menstruum. It is possible that 
the doctor did get a clear mixture, but you know what that 
means ? It means simply this : The druggist put no salicylic 
acid in the mixture, or did put in some, shook the bottle and 
filtered out the excess of acid, which in this case means prac- 
tically the entire amount. 

It is sad but true that some druggists will take liberties 
with a doctor's prescription, will change or omit ingredients 
without notifying the doctor, thus subjecting a fellow drug- 
gist, who may try to put up the prescription honestly, to 
innumerable annoyances and to suspicions of incompetence 
and dishonesty. 



PRESCRIPTION INCOMPATIBILITIES 79 

123. Liq. Plumbi Subaeet 2.5 

Mucil. Acaciae 20.0 

Aq. Menthae Pip ad 240.0 

S.: Use for gargle. 

This prescription is a favorite one with a prominent laryn- 
gologist of this city. A druggist who received it not long 
ago was unable to dispense it on account of incompatibility. 
He tried to make it up, but obtained a mess, which he could 
not distribute through the bottle. And so he telephoned to 
help him out of the difficulty. This prescription well illus- 
trates the fact, that incompatibility often depends upon the 
relative quantities of the ingredients and upon the order of 
mixing. Goulard's extract is incompatible with mucilage of 
acacia (see I£ 67), but the above may be made up as an homo- 
geneous, permanent mixture. Add the liquor plumbi to half 
of the water, the mucilage of acacia to the other half, and 
mix the two solutions. (The druggist had added the liquor 
plumbi directly to the mucilage.) The mixture has the 
appearance of diluted milk. 

124. Tr. Ferri Chlor. ^j 

Liq. Acidi Arsen. y aa 3 ij 

Quinin. Sulph. J 

Inf us. Cinchonae q.s. ad J iij 

This prescription cannot be called incompatible. The tinc- 
ture, the solution, and the infusion all contain free acid — 
the first two hydrochloric, the last sulphuric ( aromatic ) . The 
quinine is dissolved by the free acids without any difficulty, 
and neither the iron nor the arsenic will be precipitated. 
There is a darkening in color, however, due to the action of 
the cinchotannic acid on the iron ; but even that is prevented 
to a certain extent by the acid. 

125. Tr. Ferri Chlor. >, 

Tr. Nue. Vom. I aa 10.0 

Tr. Digitalis 



80 PRESCRIPTION INCOMPATIBILITIES 

Chinin, Sulph."! 

Natrii Salicyl. J 

Spir. Amnion. Aroni 20.0 

Syr. Aurant. Cort.l 

/ I aa 75.0 

Aquae J 

This is a prescription calculated to ruffle the equanimity 
and upset the equilibrium of the most placid of druggists. 
The different incompatibilities and reactions which are apt 
to take place in it are as follows: (1) The tincture of digi- 
talis will make a black mixture with the iron, producing fer- 
ric tannate; (2) the tincture of nux vomica will do the same 
thing; (3) syrup of orange peel also contains tannin, and 
will produce a similar effect; (4) the sodium salicylate reacts 
with the iron, producing ferric salicylate of a deep violet-blue 
color; (5) the salicylate reacts with the quinine sulphate, 
which is dissolved by the tincture of iron, producing the 
sticky, bulky quinine salicylate; (6) the aromatic spirit of 
ammonia, containing, as it does, free ammonia and ammonium 
carbonate, will react with the ferric chloride, producing a 
magma of ferric hydroxide and carbonate, which latter is 
soon converted into oxide; (7) the spirit of ammonia also 
reacts with the quinine sulphate, precipitating the free alka- 
loid quinine, and is apt also (8) to precipitate strychnine and 
brucine from the tincture of nux vomica. In one instance 
that the writer recalls, before an attempt was made to make 
up the prescription, the physician was consulted; but he 
said it should be made up as written. The druggist did so; 
but such an awful looking, sticky, pasty mess was obtained, 
with some dirty-looking liquor floating above, that of dis- 
pensing it there could be no question. It is impossible to 
make it up with all the ingredients in any presentable man- 
ner. One of two ways is open : either to leave out the sodium 
salicylate, or to leave out both the quinine sulphate and the 
sodium salicylate, and use quinine salicylate instead. Even 
with this modification a good deal of judgment is necessary 



PRESCRIPTION INCOMPATIBILITIES 81 

in order to compound the mixture correctly. The proper 
procedure is as follows : Add the aromatic spirit of ammonia 
to the syrup ; to this add at once the tincture of ferric chlo- 
ride — no or hardly any precipitation will take place, as con- 
centrated syrup prevents the precipitation of ferric salts by 
ammonia. Add now the tincture of nux vomica and digitalis ; 
the mixture turns black, but there is* no precipitate worth 
mentioning. Put the quinine sulphate (or the quinine sali- 
cylate, if that has been taken, which course is advisable) in 
a mortar, and incorporate it well with the mixture gradually 
added. Finally, add the water ; or still better, use about % 
or y 2 of glycerin and the balance water — precipitation will 
thereby be more surely prevented. The mixture thus ob- 
tained is not of too elegant an appearance, but can be poured 
easily, does not taste abominably, and is good enough for 
practical purposes. It is unnecessary to say that it must be 
dispensed with a "shake well" label; the bottle should also 
be kept on the side. 

126. Diuretin 3 j 

Tr. Ferri Chloridi 5 ij 

Syrupi 5 j 

Aquae, q. s ad 3 ij 

If you know the chemical composition of diuretin, you will 
have no difficulty in making out the incompatibility. Diure- 
tin is chemically theobromine-sodium and sodium salicylate; 
of the formula C 7 H 7 NaN 4 2 . NaC 7 H 5 3 . (One atom of 
hydrogen in the theobromine is replaced by an atom of so- 
dium, and this compound is united to a molecule of sodium 
salicylate). A deep violet-blue solution results, due to the 
formation of ferric salicylate. Furthermore, some theobro- 
mine is liberated and precipitated by the free acid which is 
present in the tincture. 

127. Diuretin 3 ij 

Aquae J V J 

I once ordered this mixture and instead of getting a per- 



82 PRESCRIPTION INCOMPATIBILITIES 

fectly clear solution as I expected, I got a milk-white mixture 
similar to chalk mixture. On making an inquiry, I found 
that genuine diuretin was dispensed, but the bottle (one- 
third full) had been standing on the shelf for over two years. 
The druggist had forgotten whether diuretin was soluble or 
not. I can think of no chemical which is more easily de- 
composed by exposure to the air than diuretin is. The theo- 
bromine becomes dissociated from the sodium salicylate and 
is no longer soluble in cold water. For this reason diuretin 
should never be prescribed in powders, as the air will decom- 
pose it and render it insoluble. 

128. Theobromine- Sodium Salicyl 3 iv 

Spir. Glonoini mxxxij 

Spir. Nitrous Ether 3 iv 

Ac. Phosph. Dil 3 ij 

Syr. Rub. Idaei v J ij 

Aquae q. s ad J viij 

S. : 5 ss every hour until desired effect has been produced. 

This seems to be a prescription for an urgent case of dropsy 
and suppression of urine. If so, it is a pity that the acid 
spoils its efficiency and rapidity of action to a certain extent. 
Theobromine-sodium salicylate is incompatible with acids, the 
theobromine separating and precipitating out. Besides the 
phosphoric acid, the citric acid in the syrup of raspberry 
and the nitrous acid in the spirit of nitrous ether will have 
the same tendency. Of course, salicylic acid will also be 
precipitated by the acids. 

While some pharmacists would dispense the prescription 
as written, it would be wrong to do so. The conscientious 
and advanced pharmacist would leave out the phosphoric 
acid (and perhaps also the syrup of raspberry, substituting 
a non-acid syrup) ; and would inform the physician of the 
changes made, explaining in detail the reasons which made 
the changes necessary. I am certain that the physician in 
most cases would be thankful for the information. 



PRESCRIPTION INCOMPATIBILITIES 83 

129. Tr. Iodi 3 jss 

Glycerini 3 ij 

Aquae 3 iij 

A.: For swabbing the throat. 

Iodine is soluble in alcohol, but practically insoluble in 
water. When the tincture is mixed with the glycerin and 
then with the water, the iodine precipitates. The efficiency 
of the remedy would then be greatly impaired, if indeed the 
application of undissolved iodine would not prove very irri- 
tating. There is an easy way of preventing the precipita- 
tion ; by adding a little potassium iodide ; in the presence of 
the latter, iodine is soluble in water (like in Lugol's solu- 
tion). It occasionally happens, though very seldom, that" a 
tincture of iodine is added to water and no precipitate takes 
place. This is then due to the presence of hydriodic acid 
and ethyl iodide (traces) in the tincture, which act as a sol-, 
vent for the iodine. These products — hydriodic acid, ethyl 
iodide and similar compounds — only form, if the tincture has 
been kept for a long time. 

Now, all the above refers only to the old tincture which 
was made without potassium iodide. The tincture of the 
present U. S. P. does contain KI, and the above prescrip- 
tion is therefore a perfectly compatible one. 

130. Iodi Resubllm 2.0 

Glycerini 50.0 

M. ft. sol. sec. artem. 

S. : gtt. x in aqua t.i.d. 

It requires from 50 to 60 parts of glycerin to dissolve one 
part of iodine ; only about half the amount of the prescribed 
iodine would be dissolved. In order to make it all dissolve 
and also to prevent its precipitation when added to water, as 
the physician orders, the addition of potassium iodide is 
indicated. It is not only permissible, but imperative. About 
1 gram or 15 grains should be added. 



84 PRESCRIPTION INCOMPATIBILITIES 

131. Iodine J ss 

Oil Turpentine J vj 

Alcohol 5 x 

S.: Pro Equo. 

This is a frequent combination, intended, as is seen from 
the directions, for a horse. Great care must be taken not to 
add the iodine first to the turpentine, as great heat is evolved 
and the mixture may take fire or explode; the iodine is 
thereby volatilized as a violet vapor. The right procedure 
is to dissolve the iodine in the alcohol, and then mix it with 
the turpentine oil, very gradually added. The mixture is not 
homogeneous, but separates in two layers ; there is not enough 
alcohol to dissolve the turpentine, the latter requiring three 
volumes of alcohol for solution. The upper layer consists 
of turpentine oil. Dispense with " shake" label. 

132. Sodii Sulphitis 3 vi 

Ac. Hydrochl. Dil 3 ij-3 iv 

Tr. Nuc. Vom 3 iij 

Aquae ad J iv 

Teaspoonful after meals. 

This prescription is incompatible. Sodium sulphite and 
a mineral acid should never be prescribed together, and if 
prescribed the druggist, if he knows enough, should call the 
doctor's attention to the incompatibility. The bad odor is 
due to the fact that sulphur dioxide, or sulphurous acid gas, 
is evolved through the action of the acid on the sulphite. The 
equation is as follows: 

Na 2 S03+2HCl = 2NaCl + S0 2 + H.O. 

Of course, the peculiar antifermentative action of the sul- 
phite is also lost, because the S0 2 gradually volatilizes, while 
a portion of it is oxidized to sulphuric acid. 

Do Not Prescribe Sulphites, Hyposulphites or Thio- 

SULPHATES WITH MINERAL AdDS. 



PRESCRIPTION INCOMPATIBILITIES 85 

133. Tr. Ferri Chlor I ij 

Muc. Acaeiae 

Syr. Simpl aa 3 iv 

Aquae Menthae q.s. ad J iij 

"Who does not know the incompatibility in this prescrip- 
tion? It is mentioned in some text-books; it has been dis- 
cussed time and again in the pharmaceutical journals, and 
presumably, every pharmacist should know It; but there are 
hundreds of pharmacists, and no novices either, who do not 
know it. Here is how a pharmacist put up the above pre- 
scription not so very long ago: He mixed the tincture of 
iron with the mucilage in a mortar, and to the dense gelat- 
inous mass he added and added hydrochloric acid until the 
precipitate redissolved ; he then mixed the solution with the 
syrup and the water. What a mess it was! On inquiry I 
learned that he was taught that way by another pharmacist, 
who was quite proud of his knowledge as to how to dissolve 
the precipitate formed by tincture of iron with acacia. That 
there is a much easier and nicer way which does not necessi- 
tate the unjustifiable addition of a lot of hydrochloric acid 
never seemed to have entered the mind of either teacher or 
pupil. It shows how lack of interest in one's work will 
deaden the thinking faculties and take away all desire for 
experimentation or initiative of any kind. The above pre- 
scription can be made up without the least trouble, so as to 
give a clear, transparent solution, by simply mixing first 
the tincture with the syrup, the mucilage with the water, 
and then the two solutions together. 

134. Ferri Dialysati Liq. 
Syr. Rubi Idaei 

Muc. Acaeiae aa % j 

Aquae Anisi J i j 

. The remarks made in regard to the previous prescription 
apply to this one as well. That is, mix the solution of the 
dialysed iron with the syrup, the mucilage of acacia with 
the water, and then mix the two solutions. 



86 PRESCRIPTION INCOMPATIBILITIES 

135. Salol 3 i j 

Spir. Aeth. Nitrosi J j 

Tr. Ferri. Chloridi 3 ij 

Glycerini J ss 

Aquae | v 

Salol is, chemically, phenyl salicylate, C 6 H 5 C 7 H 5 3 . When 
added to the spirit of nitrous ether it dissolves ; on now add- 
ing the tincture of iron a deep violet-hlue solution results, 
due to the formation of ferric salicylate, and partly also to 
the action of the phenyl radicle on the ferric salt. On adding 
the glycerin no change is noticed; if anything, the mixture 
gets still darker. On adding the water, the mixture becomes 
at once very turbid, and the deep-violet color is changed to 
a dirty yellowish-white. The turbidity is due to the precipi- 
tation of the salol by the water, in which menstruum salol is 
insoluble. The mixture does not remain permanently the 
same, but undergoes a notable change on standing; the salol 
precipitates, sticking to the sides and bottom of the bottle, 
while the supernatant liquid is perfectly transparent and of 
a pale-violet color. The prescription should not be dispensed 
until the prescriber has been made acquainted with the diffi- 
culty. 

13G. Zinci Iodidi gr. xv 

Aquae % ij 

S. : 3 j ter in die. 

I received this prescription with the request to explain 
the reason for the precipitation that took place on dissolv- 
ing the zinc iodide. My correspondent wrote that he at first 
dissolved the salt in plain water ; then, thinking the precipi- 
tate might be due to the impurities and the carbon dioxide 
in the water, he took distilled water and boiled it; but the 
result was the same; there was a flocculent precipitate, or 
rather sediment, floating about. This is a frequent occur- 
rence with zinc iodide ; in fact, it always take place unless 
the salt has been made but a short time and has been kept 



PRESCRIPTION INCOMPATIBILITIES 87 

in a small bottle with a ground-glass stopper. The reason 
is a simple one: Zinc iodide is not a very stable salt. It 
easily loses iodine and has a great avidity for oxygen. There- 
fore, there is but seldom a sample of zinc iodide to be found 
in the drug-stores that does not contain a small amount of 
zinc oxide or zinc oxyiodide. The only thing to do is to 
filter the solution. (If the dispenser wants to be strictly con- 
scientious, it is well to take 2 or 3 grains more than pre- 
scribed, so as to make up the loss occasioned by the filtra- 
tion.) 

137. Aquae Amni. Port. 

Collodii aa 3 ij 

S.: Apply to warts with camel's-hair brush. 

This prescription was handed me with the remark that 
the mixture became solidified, and with the question if ammo- 
nia water was incompatible with collodion. It is not the 
ammonia gas that is at fault here, but the water. Collodion 
is a solution of gun-cotton (pyroxylin or di-nitro-cellulose) 
in a mixture of alcohol and ether, and is precipitated by 
water. If plain water is used instead of the ammonia water 
the result is the same. An alcoholic solution of ammonia 
(like the formerly official "spiritus ammoniae," not "spiritus 
ammoniae aromaticus") would answer the purpose; but it is 
so seldom found in the average drug-store, that difficulty is 
likely to be encountered in having the prescription com- 
pounded properly. 

138. Collodii S j 

Aetheris 3 ss 

Aq. Amnion. Fort 3 j 

Tr. Iodi 3 iss 

By a strange coincidence, no sooner had I disposed of the 
previous prescription than I was requested to criticize the 
above. The druggist had dispensed it without giving it a 
thought, as at first it looked all right; but there really was 
very much the matter with it. The reason that no precipita- 



88 PRESCRIPTION INCOMPATIBILITIES 

tion was noticed at once was due to the extra ether entering 
into the prescription ; but after a while the pyroxylin is pre- 
cipitated out completely. That is not all, however. The 
iodine combines with the ammonia to form ammonium iodide 
and iodate; and it is due to this fact that the odor of the 
ammonia very quickly disappears (almost completely). There 
being in this prescription an excess of iodine, the mixture is 
brown at first, but gradually it becomes lighter, until in a 
short time it is perfectly colorless. Undoubtedly the excess 
of the iodine combines with the ether to form ethyl iodide. 
What is obtained in the end ? A little cotton at the bottom of 
the bottle, with a supernatant solution of ammonium iodide 
and iodate (in an ether eo-alcoholic medium). The prescrip- 
tion, as written, should not be dispensed, because both the 
protective value of the collodion and the counter-irritant 
effect of the iodine are entirely destroyed. If the ammonia 
water is omitted the prescription is all right in every respect. 
As the ammonia disappears anyhow (from its combining with 
the iodine), there can be no objection to that course; but the 
physician should be informed of the change made. 

139. Plumbi Acetatis 3 i 

Glyceriti Ac. Tannici 3 iij 

Aquae . . % iss 

"Is this prescription incompatible and would I have been 
right in refusing to dispense it?" was a query put to me re- 
cently. It should be remembered that the words "incompati- 
ble" and "non-dispensable" are not synonymous. A pre- 
scription may be incompatible, but as long as it is not danger- 
ously poisonous or explosive, and it can be poured from the 
bottle (if a mixture), we may dispense it — if the physician 
so desires. There is, of course, no question as to the incom- 
patibility of the prescription. Insoluble lead tannate is 
formed, and of course, precipitates. If the proportions are 
large an almost solid mass is formed. "Whether to dispense it 
as written or to inform the physician depends a great deal 



PRESCRIPTION INCOMPATIBILITIES 89 

on the directions. If it is to be applied externally, with lint, 
etc., there can be no objection to its being dispensed — many 
physicians believe lead tannate to be an excellent remedy 
in phlegmasia dolens, epididymitis, buboes, etc.; but if the 
mixture is to be used as a gargle, for instance, I would advise 
informing the physician. 

140. Zinci Chloridi gr. xx 

Collodii 5 iij 

S. : Apply to corn with camel's-hair brush. 

The druggist, anticipating some difficulty in dissolving the 
zinc chloride directly in the collodion, dissolved the salt in 
about half a dram of water and mixed it with the collodion ; 
thus converting it into a useless mass. The right way is to 
dissolve the chloride in a little — a few drops — alcohol (in 
which it is very soluble), and then mix the solution with the 
collodion. I have seen another druggist, wishing to put up 
an effective corn cure, mix liquor potassii hydroxidi with 
collodion, and thus spoil 8 ounces of the latter. 

141. 3 tr. Nucis Vom. 

4 Tr. Digitalis 

1 Tr. Ferri Chloridi . 

2 Ac. Phosph. Dil aa 3 ij 

5 Aquae 3 ij 

This mixture will present a somewhat different appearance, 
according to the manner in which the ingredients are mixed. 
I know of a case where ignorance of this fact cost the drug- 
gist a valuable customer. If the ingredients are mixed in the 
order in which they are written, a somewhat dark and turbid 
mixture is obtained. The tannin of the first two ingredients 
produces the tannate of iron, which is in turn decomposed 
by the phosphoric acid. If the phosphoric is first added' to 
the tincture of iron, a perfectly colorless solution is the re- 
sult, due to the formation of acid ferric phosphate. On now 
adding the tinctures, a much lighter and clearer solution is 
obtained. The druggist, above referred to, forgot the order 



90 PRESCRIPTION INCOMPATIBILITIES 

in which he mixed the ingredients the first time, and on re- 
newal the mixture had a different color. No amount of argu- 
mentation would convince the patient that no mistake had 
been made. He said he preferred to patronize more careful 
druggists. In such prescriptions the exact order of mixing 
should be noted, by the aid of figures, as shown above. 

142. Zinci Phosphidi gr. xvi 

Ac. Phosphor. Dil 3 i 

Glycerini 3 i 

Aquae Menthae q.s. ad 3 iv 

S. : 3 j three times a day, after meals. 

This prescription recalls to mind an interesting discussion 
I once had with a physician regarding the doses of medicines. 
He claimed that the doses of all the medicines, poisonous and 
non-poisonous, are too small as given in the books. He cited 
many instances to prove the truth of his assertion, and 
among other things he said: "Here is zinc phosphide. The 
dose as given in the books is from 1-16 to % of a grain. Well, 
I always prescribe it in y 2 and 1-grn. doses, and have never 
seen any bad or even disagreeable effects." This statement 
astounded me somewhat. I replied that I would never ex- 
ceed y 2 grn., and asked him in what form he prescribed it — 
in pill or capsule. "In solution," was the answer. "How 
do you dissolve it?" I asked. "Zinc phosphide is insoluble 
in water or alcohol. ' ' He replied that he never had any trou- 
ble, and showed me the above prescription. I could not re- 
frain from smiling, and that gave him a clue that something 
was wrong with his prescription. I then explained that in the 
above prescription he had practically no zinc phosphide left ; 
that the acid decomposed it, with the production of phosphine 
or phosphoretted hydrogen and zinc phosphate, and that he 
would have done much better to prescribe zinc phosphate 
from the start. The reaction which takes place may be ex- 
pressed by the following equation: 



PRESCRIPTION INCOMPATIBILITIES 91 

Zn 3 P 3 + 2H.PO* = Zn.(P04). + 2H 3 P. 
Zinc Phosphoric Zinc Phosphine. 

Phosphide Acid Phosphate 

The regular tribasie zinc orthophosphate is insoluble in 
water; and as the above mixture was perfectly clear, it is 
evident that by the aid of the excess of phosphoric acid the 
zinc acid phosphate was formed. 

The reaction would then have to be expressed as follows : 

Zn 3 P 2 + 3H 3 PO* = 3ZnHP04 + 2H.P. 

143. Aloini gr. ij 

Podophyllini gr. ss 

Calomelanos gr. v 

Pulv. Saponis q.s. 

This forms a strong cholagogue pill. Though the physi- 
cian directs that soap be taken as the excipient, it is neither 
advisable nor perhaps even permissible to do it. Soap is 
practically always alkaline, due to an excess of soda. This 
latter will convert the calomel into mercurous oxide (Hg 2 0) ; 
and even assuming that the latter would not gradually decom- 
pose into metallic mercury and mercuric oxide, it is certainly 
dangerous to take internally about 5 grs. of mercurous oxide. 
Another excipient, such as extract of gentian, should be 
taken. The black color noticed while triturating the calomel 
with the soap is due to the above-mentioned conversion of 
the calomel into the black oxide of mercury. 

Calomel, and Soap Are Incompatible. 

144. Quin. Sulph. 

Ac. Tartarici aa 3 iss 

Potass. Iodidi 3 ijss 

Syrupi Rub. Idaei 5 j 

Aquae q.s. ad J iij 

In IJ No. 40 I presented a similar prescription, but dilute 
sulphuric acid was used instead of tartaric acid; the pres- 
ence of the latter produces an additional precipitate, thus 
making a triple incompatibility. If the quinine sulphate is 



92 PRESCRIPTION INCOMPATIBILITIES 

dissolved in a part of the water by the aid of the tartaric acid, 
and a solution of the potassium iodide added to this, a fine 
crystalline precipitate is immediately formed. This precipi- 
tate is not quinine iodide, as might be supposed (that is 
formed later), but potassium bitartrate. 

KI + ILCJLOe = HI + KHC4H4O6. 

Potass. Tartaric Hyd- Cream of Tartar. 

Iodide Ac. riodic Acid. 

It will be remembered that this is the official way of mak- 
ing Dilute Hydriodic Acid. The hydriodic acid and the bal- 
ance of the undecomposed potassium iodide soon afterward 
attack the quinine sulphate, and precipitate it in the form of 
quinine hydriodide. In dispensing, the tartaric acid had 
best be left out. 

145. Iodoformi 1 „_ .. 
Hydrarg. Chlor. MitisJ J 

This prescription is said by some to be incompatible, it 
being claimed that iodine is liberated from the iodoform, con- 
verting the calomel into mercuric iodide. I take exception to 
this statement and affirm that this combination is quite com- 
patible. Iodoform liberates iodine only when exposed to 
direct sunlight; and when such a powder is prescribed, it is 
not generally set in the sun. It is more often hidden under a 
bushel. I have prescribed this combination hundreds of 
times, without ever noticing mercuric iodide. As a rule, the 
powder is used in a few days. 

146. Liq. Plumbi Subacet 3 ss 

Tr. Opii , 3 ij 

Aquae q.s. ad J iv 

There is certainly not a druggist who has not at some time 
or another dispensed this prescription. Though strictly in- 
compatible, it is nevertheless dispensed daily ; and as it seems 
to give good results to both physician and patient, we must 
not object. The incompatibility is a double one; lead being 



PRESCRIPTION INCOMPATIBILITIES 93 

an alkaloidal precipitant, precipitates the alkaloids of the 
opium ; another portion of it combines with the meconic acid 
present in the opium tincture and precipitates as lead meco- 
nate. In the case where lead acetate is used instead of the 
subacetate (as it is in the National Formulary — see "Lotio 
Plumbi et Opii"), the precipitate is not quite so heavy. 

147. Hydrarg. Chlor. Mitis gr. iij 

Ammon. Carbon gr. v 

Sacch. Laetis gr. v 

M. et ft. pulv. No. 1. Tal. dos. No. xxiv. 

There is no positive proof on hand that a very poisonous 
compound is formed on mixing the above ingredients ; never- 
theless it is better to be on the safe side, and not dispense this 
prescription. When the ammonium carbonate and calomel are 
rubbed together the color of the powder is changed to black. 
This black color is due to the formation of mercurous oxide 
(Hg 2 0) and ammonium mercurous chloride (NH 2 Hg 2 Cl) 
and, taking into consideration the instability of the mercur- 
ous compounds, there can hardly be any doubt that within 
a short time a portion of them will lose the extra atom of 
metallic mercury and pass into the mercuric state. 

148. Sol. Labarraque 

Sol. Hydrogenii Peroxidi aa 75.0 

S. : Apply to throat and nose with cotton swab. 

The activity of Labarraque 's solution, or solution of chlori- 
nated soda, depends upon the presence therein of sodium hy- 
pochlorite, which is easily decomposed, yielding chlorine. In 
the presence of the peroxide the hypochlorite becomes re- 
duced, according to the following equation : 
NaCIO + H.O. = NaCl + ILO + 2 . 

As is seen, the peroxide becomes reduced to water at the 
same time. The prescription or a part of it therefore be- 
comes practically worthless. 

Hydrogen Dioxide Should Not Be Prescribed with So- 



94 PRESCRIPTION INCOMPATIBILITIES 

lution of Hypochlorites (Labarraque's Solution or Ja- 
velle Water). 

149. Morphin. Sulph gr. ij 

Antikamnia 3 ij 

Quinin. Sulph 3 j 

Syr. Tolut 3 iij 

Ac. Sulph. Arom q.s. 

Aquae ad J j 

Teaspoonful when required. 

This prescription forcibly illustrates a tendency which 
cannot be condemned in too severe terms: the habit which 
some physicians have of prescribing, in combination with offi- 
cial or other well-known remedies, proprietary compounds, 
the exact composition of which is not known to them. How 
can the prescriber be certain that the proprietary article does 
not react with the other remedies, possibly with a deleterious 
result to both ? How can the druggist be in a position to pre- 
vent or correct an incompatibility? How can the physician 
know to which drug to ascribe beneficial results, following 
the administration of such a combination? Suppose the pa- 
tient was relieved by the above mixture; how does the physi- 
cian know whether the relief was due to the morphine arid 
quinine, or to the antikamnia? I remember one physician 
used to praise to heaven a certain alterative compound; it 
was "the anti-syphilitic par excellence." Yet he used to pre- 
scribe it invariably in conjunction with the iodides and mer- 
curials. I once asked him whether the therapeutic virtues, 
he thought the proprietary preparation possessed, might not 
be ascribed to those drugs; but he still owes me the answer. 
To return to the above prescription. If the quinine is dis- 
solved by the aid of the acid, and the antikamnia is then 
added, effervescence takes place, due to the evolution of car- 
bon dioxide. Whether precipitation will take place or not, 
will depend upon the amount of sulphuric acid. If enough is 
present to neutralize all the bicarbonate of the antikamnia, 
none will take place ; but if an insufficient quantity is taken, 



PRESCRIPTION INCOMPATIBILITIES 95 

the bicarbonate precipitates the morphine and the quinine, 
and the prescription then is a dangerous prescription to dis- 
pense. The bulk of the antikamnia, i. e., the acetanilid, will 
in any case remain undissolved. 

150. Hydrarg. Chlor. Mitis 3 i j 

Hydrogenii Peroxidi 3 ij 

S. : Apply externally three times a day. 
The statement is generally made that hydrogen dioxide 
oxidizes or otherwise changes mercurous into mercuric salts. 
This may be true of soluble mercurous salts, such as mercur- 
ous nitrate (I did not investigate that subject, as the only 
mercurous salt used in medicine is an insoluble one), but it 
must be accepted with great reservation as regards calomel. 
I shook calomel with hydrogen dioxide for many hours, and 
failed to detect any mercuric chloride. This assertion must 
therefore be based upon the following careless observation: 
When hydrogen dioxide is kept in contact with calomel and 
filtered, the filtrate will give quite an abundant precipitate 
with silver nitrate solution ; a precipitate soluble in ammonia 
water and re-precipitated by nitric acid. This shows the 
presence of a soluble chloride in the filtrate, beyond all 
doubt. On further investigation we discover that even be- 
fore being shaken with calomel, the peroxide gives a white 
precipitate of silver chloride, because the commercial article 
always contains soluble chlorides. On testing the filtrate with 
KOH,H 2 S, or copper, or any other delicate test for mercury, 
none is discoverable. It is possible that on very prolonged 
contact, some bichloride may be formed ; but then the decom- 
position may be due to other causes, such as light, etc. We 
may safely assert, however, that calomel and hydrogen diox- 
ide are not incompatible. 

151. Hydrogenii Peroxidi 5 ij 

Sol. Hydrarg. Bichloridi 1 :1000 § iv 

S. : Apply externally with cotton swab. 
This prescription is all right. I have tested this solution 



96 PRESCRIPTION INCOMPATIBILITIES 

both therapeutically, on patients, and chemically. The anti- 
septic effect was not in any way diminished, and chemical tests 
failed to discover any change either in the peroxide or in the 
corrosive sublimate. 

152. Iodof ormi 5 j 

Aq. Hydrogenii Perox 5 j 

The combination is an odd one, but not incompatible. 
Careful tests failed to discover any decomposition in the 
iodoform. The insolubility of the iodoform in the menstruum 
prevents the action of the peroxide on it. If the iodoform is 
in solution, then peroxide of hydrogen does decompose it, as 
will be seen from the next prescription. 

153. Iodof ormi 3 ss 

Aetheris Sulphurici 5 ss 

Aq. Hydrogenii Peroxidi 5 ij 

This prescription is incompatible. The iodoform dissolves 
in the ether, and on mixing the solution with the peroxide, 
iodine is liberated, as can be ascertained by adding gelatin- 
ized starch, when a deep-blue color is developed. Of course, 
the red-colored ethereal solution is not miscible with the 
H 2 2 solution. 

154. Kali Hypermangan 0.5 

Argenti Nitratis 1.5 

Aquae Destillatae 25.0 

The potassium permanganate dissolves readily in water 
and so does the silver nitrate ; but on mixing the two solu- 
tions a precipitate of silver permanganate will form, the lat- 
ter being soluble only in about 15 parts of water, according 
to my investigations. Of course, the silver permanganate will 
not remain long as such, it being soon decomposed into silver 
oxide, metallic silver, potassium manganate and manganese 
dioxide (or manganese hydroxide). 

155. Sod. Salieyl 3 v 

Sod. Bicarbon 3 iij 

Aquae Menth. Pip 3 iv 



PRESCRIPTION INCOMPATIBILITIES 97 

The patient should be told that the medicine will darken 
after a while, so that there will be no cause for alarm. A 
solution of commercial sodium salicylate always gets some- 
what brownish, and especially does the color develop in the 
presence of an alkali. 

156. Magnes. Sulph § ijss 

Spts. Menth. Pip 3 iss 

Aquae 3 iij 

S. : Two teaspoonfuls every 4 hours. 

There is just about enough water in this prescription to 
dissolve the magnesium sulphate. It will be a fully saturated 
solution. But on adding the spirit of peppermint, the entire 
mixture becomes, so to say, solid, the magnesium sulphate 
being thrown out of solution. Does any chemical reaction 
take place? None at all. It is a purely physical process. 
The MgS0 4 is insoluble in alcohol; the latter, besides, pos- 
sesses strong hygroscopic properties, and abstracts the water 
from the salt. This salt, having no solvent in which to keep 
dissolved, precipitates out. 

A Saturated Solution of Magnesium Sulphate Should 
Not Be Prescribed with Alcoholic Liquids. 

157. Hydrarg. Chlor. Mit gr. ij 

Antipyrine 3 ss 

Sod. Bicarb 3 ij 

M. et ft. pulv. No. xij. S.: One every hour. 

In one of the early prescriptions (No. 37) it was stated that 
when calomel is triturated with antipyrine, some corrosive 
sublimate is formed. The following reaction is supposed to 
take place : 

6Hg CI + 2CuHi 2 N 2 + H 2 = Hg 2 + 
Calomel Antipyrine Water Mercurous oxide 
2 HgCl 2 + Hg 2 + 2CuHi 2 N 2 0.HCL 
Mercuric Metallic Antipyrine 
Chloride Mercury hydrochloride 



98 PRESCRIPTION INCOMPATIBILITIES 

Pains were taken to explain that, as but a small propor- 
tion of the calomel (one-tenth or less) is converted into cor- 
rosive sublimate, little hesitation need be felt in dispensing 
calomel and antipyrine, when the former is prescribed in 
small doses, as fractional parts of a grain. The above pre- 
scription may be dispensed with safety, as the prescribed dose 
of the calomel is but 1-6 grain, and the sublimate that will 
form will not exceed 1-60 or 1-100 grain. 

As to the incompatibility between the calomel and the so- 
dium bicarbonate, the author considers it imaginary. At any 
rate, for practical purposes, it may be disregarded alto- 
gether, as even some of those who claim that the two chem- 
icals are incompatible, say that it takes from six to eight 
weeks before any corrosive sublimate is formed. Far from 
considering them incompatible, I together with the entire 
medical profession, consider calomel and sodium bicarbonate 
a very eligible combination. When calomel is prescribed in 
large doses, the tendency to griping seems to be distinctly 
obviated by the addition of a little sodium bicarbonate. 

158. Morph. Hydroehl gr. ij 

Potass. Cyanidi gr. ij 

Syr. Ipecac 3 ij 

Vin. Antimonii 3 ij 

Syr. Tolutani J ss 

Aquae q.s. ad 5 ij 

S.: 3 j q. 4 h. 

This mixture, which was dispensed without a shake label, 
caused quite alarming symptoms towards the end. The symp- 
toms were those of an overdose of morphine, combined with 
those of an excess of cyanide. The potassium cyanide reacts 
with the morphine salt, precipitating it as morphine cyanide ; 
and a small portion may be precipitated as free morphine by 
the potassium carbonate, which is usually present in potas- 
sium cyanide. It is best not to dispense this mixture. If 
it is, a shake label should accompany it invariably. 



PRESCRIPTION INCOMPATIBILITIES 99 

159. Mercauro 5 J 

Strychn. Nitratis gr. iij 

Atropinae Sulphatis gr. ij 

S.: Ten drops in water, four times a day. 

This very potent prescription, which again illustrates the 
reprehensible desire of some physicians to get half a dozen 
physiologic effects out of the same bottle, was presented to 
a druggist a few days ago. He knew enough to refuse to 
dispense it as written and to inform t^e prescriber that it 
would make a dangerous combination. The bromides of gold 
and mercury present in mercauro will precipitate the alka- 
loids. 

160. Ferri et Quin. Citr. Solub 3 ij 

Liq. Ainmon. Acetatis J ij 

Syrupi J ss 

Aquae 5 iv 

On dissolving the iron and quinine citrate in the water and 
adding the solution of ammonium acetate, a white precipitate 
is noticed. The precipitate is not due to the iron in this case, 
as ferric acetate is very soluble, and ferric citrate is not pre- 
cipitated by ammonia water. The precipitate which grad- 
ually forms is quinine acetate. If the solution of ammonium 
acetate be strongly alkaline, i. e., if it contain an excess of 
ammonium carbonate, a portion of the quinine citrate will 
be precipitated as alkaloidal quinine. At best it is a very 
inelegant combination. 

161. Salis Seignetti 3 iss 

Tr. Ferri Sesquichlor 3 iij 

Spiritus Nitr. Dulc 3 j 

Syrupi Tolutani 3 K 

Aquae Fontanae 3 v 

M.D.S.: Cochlear magnum ter in die post cibum. 

This is the prescription of an old physician, which I made 
up a number of times. Sal Seignette is another name for 
Rochelle salt. (Seignette was an apothecary in Rochelle who 



100 PRESCRIPTION INCOMPATIBILITIES 

first introduced this double tartrate of potassium and so- 
dium.) On dissolving the Rochelle salt in the water and mix- 
ing with the other ingredients the mixture becomes turbid, 
and within a * few seconds a heavy crystalline precipitate 
forms. The solution of the problem is very simple. The 
tincture of iron contains a considerable amount of free hy- 
drochloric acid. This acid (and also the nitrous acid usually 
found in spirit of nitrous ether) decomposes the Rochelle 
salt, with the formation of sodium chloride and cream of 
tartar, which latter precipitates. The reaction may be shown 
as follows: 

KNaCJLOe + HC1 = NaCl + KHCJLOe. 

The alcohol in the iron tincture and the spirit aid in the 
precipitation, as potassium bitartrate is almost absolutely 
insoluble in alcohol. The iron has nothing to do with the 
reaction. It is true that a solution of ferric chloride also 
decomposes Rochelle salt, but not because it is iron, but be- 
cause it is strongly acid (containing some free HC1). 

162. Aquae Hydrog. Peroxidi 5 i y 

Glycerini I ij 

Ac. Hydrochlor. Dil 3 i 

S.: 3 ij after each meal. 

A druggist refused to dispense the above prescription 
because he read somewhere that peroxide of hydrogen and 
glycerin were incompatible. In fact such a statement has 
been made a number of times in pharmaceutical journals. 
The statement is false. Hydrogen dioxide and glycerin are 
perfectly compatible in any proportions, and the mixture 
does not deteriorate even after standing for months. 

163. Hydrogenii Perox 10.0 

Ac. Chromici 1.0 

S. : Caustic. For doctor's use only. 

The doctor could just as well have allowed this " caustic' ' 
into the patient 's hands, as it was no longer caustic and 



PRESCRIPTION INCOMPATIBILITIES 101 

was powerless for harm or for good. This prescription illus- 
trates beautifully the remarkable property of hydrogen per- 
oxide to exercise first its oxidizing, then its reducing power 
on the same substance. On mixing the above substances a 
blue color is at once formed, due to the oxidation of the 
chromic acid (chromic trioxide) into perchromic acid (chro- 
mic pentoxide), but soon the blue color disappears, and a 
brownish amorphous powder precipitates. This precipitate 
is chromium sesquioxide, formed by the reduction of the 
perchromic acid. The following two reactions make the 
changes plain: 

CrOs + 2H.O. =CrO s + 2H*O a 

Chromic Hydrogen Perchromic Water 
Acid Diox. Acid 

Cr0 5 + 3H 2 O a = CR 2 3 + 3ILO + 50. 
Perchromic Chrom. Water Oxygen 

Acid Sesquiox. 

This evolution of oxygen is quite abundant, as can be 
demonstrated by applying a glowing match to the mouth of 
the bottle or test-tube. 

164. Hydrarg. Bichlor. Corr gr. iij 

Sodii Boratis 3 iss 

Aquae Destill q.s. ad | iij 

In one week the writer received two prescriptions like the 
above ; they both came from Brooklyn pharmacists, and orig- 
inated from the same physician. On dissolving the salts and 
mixing the solutions, a brownish-red precipitate forms, con- 
sisting of mercury oxychloride, with probably some mercury 
borate. There is no mercury left in the supernatant liquid, 
as is shown by applying the various tests for mercury. How 
can this precipitation be prevented? We studied the prop- 
erties of borax and its behavior with glycerin in previous 
prescriptions. We know that glycerin decomposes borax into 
boric acid and sodium metaborate. On adding some glycerin 
to the solution of the borax and then adding the corrosive 
sublimate, no red precipitate will be formed. In fact, it 

f 



102 PRESCRIPTION INCOMPATIBILITIES 

might seem at first that with this modification the prescrip- 
tion is all right. But it is not. After a short while a slight 
whitish precipitate will be found throughout the liquid and 
at the bottom of the vessel. Whether this is mercury meta- 
borate, or whether it is due to the impurities present in com- 
mercial borax, has not been determined; the prescription 
should not be dispensed. The only way out of the difficulty 
is to substitute boric acid for borax ; on mixing HgCl 2 with a 
solution of boric acid, a perfectly clear solution is obtained, 
and one that remains so indefinitely. 

165. Sacchari Saturni gr. vj 

Kali Hydriodiei gr. viij 

Syr. Violarum 3 iv 

Aquae Fontanae 3 j 

The first ingredient is sugar of lead, or lead acetate; the 
second, potassium iodide; the third, syrup of violets (a syrup 
well known in Europe and prepared from the fresh flowers of 
viola odorata, our " sweet-blue ' ' violet) ; and the fourth, 
spring water. It does not require much knowledge of chem- 
istry to be aware of the fact that the first two ingredients 
are incompatible. Lead iodide precipitates. The reaction 
is as follows : 

Pb(C 2 H 3 2 ) 2 + 2KI = PbL + 2KC 2 H 3 2 . 

When the potassium iodide is greatly in excess over the 
lead acetate, the precipitate will redissolve, as lead iodide is 
soluble in a concentrated solution of potassium iodide form- 
ing a double iodide of potassium and lead. 

166. Iodof ormi 3 j 

01. Olivae 5 ij 

Aquae ILO2 J ij 

Pulv. Aeaciae q.s. 

This prescription is incompatible. The iodoform being 
dissolved in the oil, the peroxide reacts on it with the evolu- 
tion of iodine. Impurities in the fixed oil will also sometimes 



PRESCRIPTION INCOMPATIBILITIES 103 

cause the liberation of the iodine. (See also prescriptions 
152 and 153.) 

167. Zinci Sulphatis gr. xviij 

Bism. Subnitr 3 ss 

Aq. Hydrogenii Dioxidi J iij 

Aquae J iij 

I have tested the action of ZnS0 4 and BiON0 3 on the hy- 
drogen dioxide, separately and in combination, but found no 
decomposition; consequently, this prescription may be con- 
sidered compatible. 

168. Liq. Hydrogenii Peroxidi 3 vj 

Bals. Peruviani 3 ij 

S.: Apply with camel's-hair brush. 
At first no deterioration in the strength of the peroxide 
could be detected. On repeatedly shaking it, as is always 
necessary before applying it, the peroxide will become weaker, 
but then H 2 2 , even if shaken by itself, without any for- 
eign substance, will become partially decomposed into water 
and oxygen. But the pharmacist has no reason for not dis- 
pensing the above prescription. 

169. Liq. Hydrogenii Dioxidi 

Tr. Arnicae I aa 3 i j 

Ext. Calendulae Fid. 

This prescription was presented to me for analysis. After 
the mixture stood for some days I tested it for the peroxide 
by applying some to a pus cavity, and by the potassium chro- 
mate and ether test, and found no appreciable diminution in 
strength. 

170. Cupri Sulphatis 3 j 

Sodii Bicarbon 3 j 

Aquae 3 ij 

S. : Apply with brush to ulcerated surface. 
This prescription is absolutely incompatible, and the drug- 
gist would do the physician a kindness by leaving out the 



104 PRESCRIPTION INCOMPATIBILITIES 

sodium bicarbonate. It is seen at once that what the physi- 
cian wants is, to use the copper sulphate as a caustic applica- 
tion. By adding the sodium bicarbonate he completely de- 
stroys the caustic effect, as the copper is precipitated as cop- 
per carbonate, which is insoluble and non-caustic. By mix- 
ing the ingredients and at once corking the bottle, there is 
also danger of explosion, as a considerable amount of C0 2 
is evolved. The following equation will show what reaction 
takes place: 

CuSO* + 2NaHC0 3 = CuC0 3 + Na 2 S0 4 + CO, + H.O. 

The right course to pursue is to inform the physician and 
get his consent to omit the sodium bicarbonate. 

Copper Sulphate Is Incompatible with Sodium Bicar- 
bonate. 

171. Tr. Ferri Chlor. 5 i j 

Morph. Sulph gr. iij 

Glycerini , 3 ss 

Aquae q.s. ad J iij 

This is a well-known incompatibility. Morphine with fer- 
ric salts strikes a bluish-green color ; in fact, this is a test for 
morphine. The formation of the color is prevented by the 
presence of free acid, but it is rare that tincture of iron con- 
tains so much free acid as to prevent the reaction. In this 
case it is best to inform the physician of the facts, and let 
him act as he sees fit. 

Morphine Is Incompatible with Ferric Salts. 

172. Hydrarg. Iodidi. Flavi gr. xxiv 

Potass. Iodidi 3 iij 

Syr. Sarsapar. Comp 3 ij 

Aquae 5 j 

S. : 3 j 4 times a day. 

This is an incompatible and extremely dangerous prescrip- 
tion ; the more dangerous because if the syrup of sarsaparilla 
be added at once the druggist may notice no change in the 



PRESCRIPTION INCOMPATIBILITIES 105 

physical appearance and dispense it without hesitation. Mer- 
curous iodide, in the presence of potassium iodide or any 
soluble iodide, becomes at once decomposed into mercuric 
iodide and metallic mercury. For practical purposes it is 
sufficiently accurate to remember that one part of mercurous 
iodide will form about two-thirds of one part of mercuric 
iodide. The equation and the calculation are as follows: 

2HgI = Hg + HgL 

654 = 200 + 454 

That is to say, 654 parts, when decomposed, will form 
454 parts of mercuric iodide ; reduce those figures (it cannot 
be done exactly) and two-thirds will be the approximate 
answer. In the above prescription there is 1 grain per dose 
of the mercurous iodide; this would give % grain of mer- 
curic iodide per dose, which dose might produce distinctly 
toxic effects, especially if repeated four times a day. There 
is also in that prescription about 8 grains of finely divided 
metallic mercury, but no danger need be apprehended from 
this source, as metallic mercury may be taken in quite large 
doses. The pharmacist should refuse to dispense this pre- 
scription and communicate with the physician. 

Mercurous Iodide Forms a Dangerous Incompatibility 
with Potassium Iodide, or Any Other Soluble Iodide. 

173. Hydrarg. Iodidi Flavi 0.01 

Potass. Iodidi 0.075 

M. et ft. pil. No. 1. D. Tal. Dos. No. xxiv. 
S.: One pill three times a day. 
This and the previous prescription will illustrate what 
the author has been trying to impress many times, namely, 
that "incompatible" and "non-dispensable" are not synony- 
mous terms. A druggist received, the above prescription, 
and knowing that the two ingredients were incompatible, he 
sent to the physician, stating the fact. The latter said he 
wanted to have the prescription put up just as written. 
The druggist still hesitated, basing himself on the statement 



106 PRESCRIPTION INCOMPATIBILITIES 

of the U. S. Dispensatory, which says: "It (yellow mercur- 
ous iodide) should never be given at the same time with 
potassium iodide, which converts it immediately into mer- 
curic iodide and metallic mercury." He consulted me as 
"final authority/' and I advised him to dispense the pre- 
scription. The chief difference between the two prescrip- 
tions is in the dose. This one contains only 1-6 grain of 
mercurous iodide, which, even assuming that it becomes en- 
tirely decomposed, will yield only 1-9 grain of mercuric 
iodide, and that is a perfectly safe dose. Thus, the question 
"to dispense or not dispense," frequently turns on the size 
of the dose. Another difference between this and the pre- 
ceding prescription is that many druggists will in this case 
use the dry potassium iodide, mix it with some inert powder, 
as althea or licorice, and then make a pill mass with some 
mucilage of acacia or glycerite of starch. In this condition 
only a portion of the mercurous iodide will be decomposed. 

174. Spts. Ammon. Arom. 

Syr. Gallae aa J i 

Aquae Cinnamonii 3 ij 

This combination forms an unsightly precipitate, due to 
the combination of the tannic and gallic acids in the nutgall 
syrup with the ammonium carbonate in the spirit. Syrupus 
gallae, or syrupus gallae aromaticus, was a great favorite 
with the physicians of two generations ago, and a very pow- 
erful and effective syrup it was. Now it is almost completely 
forgotten, but is still occasionally prescribed by those who 
cling to the old traditions. 

175. Hydrarg. Chlor. Mitis gr. xvj 

Amm. Chloridi gr. xij 

Sacch. Lactis gr. xx 

Div. into pulv. No. iv. 
The result in this prescription will depend a good deal on 
the quality of the ammonium chloride. If a salt answering 
the Pharmacopeial requirements be used, there need be no 



PRESCRIPTION INCOMPATIBILITIES 107 

fear of any incompatibility. The writer believes that no 
mercuric chloride is formed. If any is formed, it is so infini- 
tesimal in amount as to be disregardable altogether. But if 
the commercial impure muriate be used, the prescription may 
be considered incompatible. In several triturations which 
the writer made he could discover decomposition after several 
hours; the powders contained mercurous oxide, metallic mer- 
cury, mercuric chloride, and probably also dimercur-ammo- 
nium chloride. In some cases the powder became of a grayish 
color after two minutes' trituration. 

176. Hydrarg. Chlor. Mit 5 j 

Ammon. Carbon 3 j 

Sacch. Albi 3 ss 

Div. into pulv. No. xij. 

This prescription is positively incompatible. When ammo- 
nium carbonate is rubbed with calomel, a gray color develops 
at once. This is due to the formation of the black ammo- 
nium-mercurous chloride, or dimercur-ammonium chloride, 
NH 2 Hg 2 Cl. This compound may not be actively poisonous, 
but the chemical composition of the calomel and the external 
appearance of the powder are so changed that the prescrip- 
tion should under no circumstances be dispensed. The ammo- 
nium carbonate is to be left out. The writer vividly remem- 
bers when he received this prescription the first time and 
made it up. It was in the good old junior days, when every 
day brought some new facts, some new knowledge, some new 
discovery. When he saw the powder turning black he called 
the employer 's attention to it. The latter, a European Master 
of Pharmacy (Magister Pharmaciae), explained that those 
two drugs were incompatible and recommended to leave out 
the ammonium salt, which he did, and notified the physician 
to that effect. The next morning brought a reply from that 
physician full of thanks and apologies. 

Calomel Is Positively Incompatible with Ammo- 
nium Carbonate. 



108 PRESCRIPTION INCOMPATIBILITIES 

177. Hydrarg. Chlor. Mit 3 j 

Ac. Hydrochlor. Dil 3 ss 

Syr. Rhei Arom J ss 

Aquae ad § ij 

A physician who will prescribe a heavy powder like calo- 
mel in a shake mixture is a very poor prescriber. Perhaps 
he is not aware of the fact that calomel is insoluble. In 
this prescription the patient may get in one dose anywhere 
from 2 to 10 grains of calomel, and the physician can cer- 
tainly not expect uniform or satisfactory results. This is 
the only thing wrong with this prescription. The fear of 
there being formed corrosive sublimate from the action of 
the hydrochloric acid on the calomel is groundless. The 
writer failed to discover any with the most delicate tests. 

Calomel Is NOT Incompatible with Hydrochloric Acid. 

178. Hydrarg. Chlor. Mit 3 i j 

Syr. Rhei -^ __ 2 . 

/ I aa 3 jss 

Aquae j 

S. : 3 i twice a week on going to bed. 

This prescription is incompatible, though it may not ap- 
pear so at first glance. Syrup of rhubarb contains potassium 
carbonate; the latter will convert a portion of the calomel 
into black mercurous oxide, and gradually there may form 
some mercuric oxide and metallic mercury. 

179. Tr. Ferri Chlor. 
Potass. Brom. 

Sodii Brom aa 10.0 

Glycerini 15.0 

Aquae q.s. ad 60.0 

The bromides, like the iodides, are incompatible with ferric 
chloride. The latter decomposes them with the liberation of 
bromine or iodine, as the case may be. JThe equation is as 
follows : 

2KBr + 2FeCl 3 = 2KC1 + 2FeCL + Br* 



PRESCRIPTION INCOMPATIBILITIES 109 

As is seen, the ferric chloride is converted into ferrous 
chloride. 

As free bromine is irritating to the stomach, the prescrip- 
tion should hardly be dispensed without informing the physi- 
cian of the facts. 

180. Camphorae Monobrom gr. iij 

Chlorali Hydrati gr. v 

Lupulini gr. i j 

M. et ft. caps. No. 1. 
"When monobromated camphor and hydrated chloral are 
triturated together, a soft moist mass is formed, which on 
further trituration becomes semi-liquid or liquid. Neverthe- 
less, the prescription may be dispensed, as follows: Rub the 
monobromated camphor with some absorbent powder, such 
as starch or althea; do the same thing with the chloral and 
lupulin; then mix the two powders gently with a spatula, 
without trituration, and fill into capsules. Should the cap- 
sules come out too large, double the number may be filled, 
and the patient ordered to take two capsules instead of one. 
The capsules should be kept in a cool and dry place. 

181. Magnes. Calcinatae 3 ij 

Pancreatini 3 ij 

Bism. Subnitratis J iss 

M. ft. pulvis. Detur at scatulam. 

S.: Take as much as can be placed on a twenty-five cent 
piece 3 times a day after meals. 
Druggists rarely affix a "shake well" label to boxes con- 
taining bulk powders. Nevertheless, it is occasionally as nec- 
essary as with some liquid mixtures. We are apt to forget 
that powders possess different specific gravities, and if such 
powders be mixed and not shaken frequently they will sep- 
arate and form different layers, almost in the same manner 
as two or more immiscible liquids of different specific gravi- 
ties do. The writer has made experiments on the subject, 
and found that if the powders be of different colors the dif- 
ferent layers can be beautifully demonstrated. In this pre- 



110 PKESCRIPTION INCOMPATIBILITIES 

scription almost the entire bismuth subnitrate will be found 
on the bottom, while the magnesia will be on top. The only- 
way to obviate the difficulty is to direct the patient to shake 
the box well before taking the powder. This method of pre- 
scribing, while very common with German physicians, is not 
to be commended. Its only recommendation is cheapness. 

182. Liq. Hydrogenii Dioxidi 5 j 

Acidi Carbol gr. xv 

Tr. .Ferri Chlor 3 i j 

Glycerini § i 

Aquae q.s. ad 3 iv 

S. : 3 j four times a day in a little water. 

This is one of the best possible specimens of incompatibil- 
ity. On mixing the first three ingredients a violent reaction 
takes place at once; intense heat is generated, a very strong 
empyreumatic odor becomes noticeable, and the mixture 
froths and turns perfectly black. Of course, nobody would 
dispense such a mixture. The exact reaction is too compli- 
cated to be given here; one thing may be stated; the car- 
bolic acid reaches the highest point of oxidation, and may be 
said to be completely "burned up." 

183. Potass. Permang 3 ss 

Acidi Carbolici 3 ss 

Aquae 3 i y 

This is another example of the desire to get too much, but 
of getting nothing instead. Both ingredients are antiseptics, 
but react upon each other with the following result : The po- 
tassium permanganate becomes reduced, while the phenol is 
oxidized to oxalic acid and carbon dioxide. The following 
equation shows the reaction: 

CelLOH + 12KMn0 4 = 2H 2 C 2 4 +' 
Phenol Potass. Oxalic 

Permang. Ac. 

2CO* + H.0 + 6K 2 Mn0 4 + 6Mn0 2 
Carbon Water Potass. Manganese 

Dioxide, Manganate Dioxide 



PRESCRIPTION INCOMPATIBILITIES 111 

No pharmacist will think of dispensing this mixture, as it 
is too nasty-looking; if the quantity of potassium perman- 
ganate is larger, a solid or semi-solid mass is obtained on 
account of the manganese dioxide which precipitates. (In 
this prescription the quantity of phenol is excessive \ not 
more than 2 drams will dissolve in 4 fl. ozs. of water.) 

184. Potass. Permang 3 ss 

Ac. Salicylici 3 j 

Aquae j 

S. : Dip a cloth and apply to ulcer, changing every half 
hour. 
A black mixture is obtained at once. The potassium per- 
manganate becomes reduced to potassium manganate and 
manganese dioxide ; while the salicylic acid is decomposed into 
formic acid and carbon dioxide. The reaction may be ex- 
pressed as follows: 

HC7ILO3 + lOKMnO* + H2O = 4HCH0 2 + 
Salicyl. Potass. Water Formic 

Acid Permang. Acid 

3C0 2 + 5K 2 Mn04 + 5Mn0 2 

Carbon Potass. Mangan. Dioxide. 

Dioxide Manganate 

It should be understood that all statements concerning re- 
actions in which potassium permanganate is one of the fac- 
tors are only relatively correct ; because the reaction depends 
to a great extent upon the quantity of the permanganate 
present, the concentration of the solution, the temperature 
employed, etc. For instance, there can be no doubt that if 
sufficient permanganate be present, even the formic acid will 
undergo further oxidation until it is split up into carbon 
dioxide and water ; thus : HCH0 2 -f O = C0 2 + H 2 0. 

The patient who had an ulcer of many years ' standing said 
that he had derived more benefit from this mixture than from 
anything he had ever used. His ulcer was eventually healed. 
Was it time for it to get healed, was it the formic acid, was it 
the balance of the undecomposed salicylic acid — who will 



say 



112 PRESCRIPTION INCOMPATIBILITIES 

185. Codeinae gr. iv 

Ammon. Chlor 3 j 

Syr. Ipecac 3 i j 

Syr. Tolu 3 i 

Aquae q.s. ad 3 ij 

S.: Teaspoonful every 3 hours. 

This prescription cannot be considered incompatible. It is 
true that codeine, having a strong alkaline reaction, liberates 
some ammonia gas from the ammonium chloride (the same as 
potassium or sodium hydroxide does), but the quantity is 
so small that it may be disregarded. It is best not to bring 
the codeine and the ammonium chloride together at once, 
but to dissolve each separately and then mix the solutions. 

186. 01. Tiglii min. viij 

01. Ricini 3 i 

Glycerini 3 iij 

S. : Teaspoonful every hour until bowels have operated 
freely. 

Physicians and many druggists regard glycerin in the 
nature of a fat or fixed oil, and think that both fixed and 
volatile oils are freely miscible with it. They are quite sur- 
prised when they find out that the contrary is the case. The 
people attending the patient must be directed to shake the 
bottle very thoroughly each time before administering the 
medicine. Otherwise the mixture of the two oils will be 
on top of the glycerin, and the patient may get all or half 
of the croton oil at one dose. The dose of the croton oil — 
2 drops every half hour — seems rather large, but as it was 
for a case of lead colic, where a quick operation was abso- 
lutely necessary, it was probably all right. 

187. Ac. Salicylici 3 ss 

Aquae Calcis 3 viij 

S. : Apply externally. 
Glancing casually at the prescription we might think that 
the greater part of the salicylic acid will remain undissolved ; 



PRESCRIPTION INCOMPATIBILITIES 113 

the solubility of salicylic acid in water being 1 in 460, only 
about 1 grain dissolves in one ounce of water, and it would 
require about 28 ounces of water to dissolve the entire quan- 
tity of salicylic acid prescribed. But in this case we get a 
perfectly clear solution, the reason being that a chemical 
reaction takes place, the salicylic acid combining with the 
calcium hydroxide to form calcium salicylate. Of course the 
lime water must contain some lime. Some samples which 
we had occasion to analyze were found to be absolutely free 
from lime. 

188. Ac. Salicylici gr. x 

Hydrarg. Chlor. Mitis gr. x 

Liq. Calcis 5 ij 

S. : Apply externally as directed. 

This prescription has caused considerable trouble in one 
drug-store. The first time the proprietor made it up, and he 
dispensed it as a mixture with a white sediment; on being 
renewed, the clerk dispensed it, and it was a black mixture. 
The patient brought it back and a lot of explanations had 
to follow. The first time it was made up by adding the 
salicylic acid to the lime water; that neutralized the calcium 
hydrate, forming calcium salicylate [Ca(OH) 2 + 2HC 7 H 5 
3 = Ca(C 7 H 5 3 ) 2 -f- 2H 2 0] ; on then adding the calomel, 
no further reaction took place, and the result was a white 
mixture. The second time the calomel was added directly 
to the lime water ; that produced the black oxide of mercury 
[Ca(OH) 2 + 2HgCl = Hg 2 + CaCl 2 + H 2 0], "which re- 
mained unchanged on the subsequent addition of salicylic 
acid. 

189. Tr. Nuc. Vom 3 iss 

Tr. Ferri Chlor 3 iv 

Potassii Hypophosph 3 ii 



Sodii Hypophosph. 
Calcii Hypophosph 



j- aa 3 ii j 



114 PRESCRIPTION INCOMPATIBILITIES 

Essence Peps. (Fairchild) J j 

Elixir Peptenzyme ^ j 

Glycerini J ss 

Aquae q.s. ad J vj 

S.: 3 i ter in die, post cibum. 

The correspondent sending this prescription asked what 
the matter with it was, and whether it should have been dis- 
pensed as written. This is a very nice prescription, theoret- 
ically. The doctor seeks to combine the tonic effect of mix 
vomica, the hematinic actions of the iron, the * * neuro-nutri- 
ent" effects of the three hypophosphites, and the digestive 
effects of pepsin and peptenzyme. But the mixture cannot 
be dispensed; not in a presentable form, at any rate. The 
trouble is between the hypophosphites and the ferric chlo- 
rides; the insoluble ferric hypophosphite forms at once and 
precipitates. If the solutions are concentrated enough, a 
gelatinous, almost solid mass is produced. 

Can this precipitation be prevented? Well, by using a 
sufficient amount of hypophosphorous acid or potassium (or 
sodium) citrate, it can; but this prescription already con- 
tains so many ingredients that it is hardly justifiable to add 
any more. The tincture of iron might be left out altogether. 
However, there is a better way, which will certainly appeal 
to the physician, and that is to substitute another ferric com- 
pound for the ferric chloride. The most eligible salt in this 
case is the ammonio-ferric citrate (Ferri et Ammonii citras, 
U. S. P.). No precipitation takes place between this ferric 
salt and the" hypophosphites. As to the amount of ammonio- 
ferric citrate which corresponds to the quantity of tincture 
ordered, a slight calculation will give the result. Tincture 
of iron contains an amount of FeCl 3 , corresponding to 4.7 
per cent, of metallic iron; the citrate of iron contains 16 
per cent, of Fe. Seventy-one grains of the latter will, there- 
fore, be the equivalent in metallic iron of half an ounce of 
the former. 



PRESCRIPTION INCOMPATIBILITIES 115 

190. Tr. Ferri Chlor 3 vi 

Syr. Hypophosphitum ad J iij 

S. : 3 i t.i.d. 

An almost solid mass results, or a thick liquid with an 
unsightly precipitate. The cause is the same as in the pre- 
vious prescription; the formation of ferric hypophosphite, 
Fe(PH 2 2 ) 3 . Potassium citrate dissolved in the smallest 
amount of water possible, or simply dissolved in the syrup, 
should be used to prevent the formation of the precipitate 
or to dissolve it after it has formed. A perfectly clear solu- 
tion of a greenish color is the result. 

191. Tr. Ferri Chlor 3 ii 

Syr. Hypophosphitum 3 j 

Aquae ad J i j 

If the tincture is first mixed with the water and the syrup 
then added, no precipitation will take place. Should the first 
two ingredients have been mixed with the formation of a pre- 
cipitate, the water will redissolve it. Ferric hypophosphite 
is slightly soluble in water, especially in the presence of hypo- 
phosphorous acid, a trace of which is present in the syrup. 

192. Tr. Iodi 3 i 

Liq. Hydrog-enii Dioxidi 5 ij 

S.: For external use. 

This prescription is incompatible and should not be dis- 
pensed. 

In the above there soon commences quite an active reac- 
tion between the iodine and the peroxide; the iodine is con- 
verted into hypo-iodous acid, according to the following reac- 
tion: 

2I + H 2 2 = 2HIO. 

This, as will be seen, is similar to the reaction which takes 
place on mixing chlorine water with solution of hydrogen 
peroxide. But here the similarity ceases. While the hypo- 
chlorous acid on coming into contact with another molecule of 



116 PRESCRIPTION INCOMPATIBILITIES 

H 2 2 becomes reduced to hydrochloric acid (with liberation 
of oxygen : HCIO + H 2 2 = HC1 + H 2 + 2 ) the oppo- 
site reaction takes place with the hypo-iodous acid; instead 
of becoming reduced to hydriodic acid, it becomes oxidized to 
iodic acid. Reaction as follows: 
HIO + 2H.O. = HI0 2 + 2ILO. 

The writer has established these facts beyond doubt ; care- 
ful chemical analysis proved the absence of hydriodic acid, 
while showing the presence of iodic acid in abundance. 

193. Potass. Permang 3 ss 

Ferri Sulphatis 3 j 

Ac. Sulph. Dil 3 ij 

Magnes. Sulphat 3 ij 

Syr. Zingiberis 3 ij 

Aquae q.s. ad 3 viij 

This combination minus the potassium permanganate is 
the favorite prescription of a very well-known gynecologist 
of this city in many female ailments. The above was writ- 
ten by a young practitioner, who thought he would improve 
it by adding the salt which is reputed to be so useful in 
amenorrhea. The permanganate is decomposed, while the 
ferrous salt is converted into the irritant and astringent fer- 
ric sulphate ; thus : 

2KMn0 4 + lOFeSO* + 8H 2 SO*:=2MnS04 + 5Fe 2 (S0 4 )3 
Potass. Ferrous Sulphuric Manganous Ferric 

Permang. Sulphate Acid Sulphate Sulphate 

+ K 2 SO* + 8H.O. 
Potass. Water 

Sulphate 

194. Ammonii Benzoatis 3 ij 

Sodii Benzoatis 3 vi 

Tr. Ferri Chloridi 3 iv 

Tr. Gentianae 3 iss 

Syr. Aurantii Fl 3 i 

Aquae ad 3 vi 

In this prescription a voluminous precipitate filling the 



PRESCRIPTION INCOMPATIBILITIES ill 

entire bottle is formed. All soluble benzoates are incom- 
patible with ferric salts, insoluble ferric benzoate being 
formed. The precipitate is described as flesh-colored, but I 
do not think that that expression aptly describes it. It is 
rather a light-brown or buff color. If the two tinctures are 
mixed first a dark mixture will result, on account of the 
tannic acid in the gentian producing with the iron the black 
ferric tannate. 

195. Kali Iodati 3 vi 

Aquae Regiae 3 ij 

Aquae Fontanae 3 iij 

S.: Cochlear parvum post cibum. 
This mixture soon turns dark brown. Nitrohydrochloric 
acid contains free chlorine, which decomposes the potassium 
iodide, with the liberation of iodine. If taken by the patient, 
this mixture would be liable to prove extremely irritating. 

196. Resorcin gr. iij 

Antipyrine gr. vii j 

Phenacetin gr. ij 

M.f . pulv. No. 1. Dent. Tal. Dos. iv. S. : One every hour. 
Resorcin is incompatible with antipyrine; when prescribed 
in powder form, they liquefy, especially in damp weather. 
There is no way of preventing it, except by placing the re- 
sorcin on top of the antipyrine and phenacetin, without any 
trituration; or by putting the resorcin in separate powders. 

197. Tr. Ferri Chloridi 10.0 

Resorcinol 5.0 

Glycerini 20.0 

Aquae 100.0 

Resorcin is very similar in most of its reactions to phenol. 
Carbolic acid is a monatomic phenol, while resorcin is a dia- 
tomic phenol, that is, one hydrogen in the carbolic acid is 
replaced by a hydroxide. The deep violet-blue color of this 
mixture is due to the reaction between the ferric chloride and 
the resorcin. 



118 PRESCRIPTION INCOMPATIBILITIES 

198. 01. Terebinthinae 3 iij 

Morph. Aeetatis gr. i 

S. : Every six hours fifteen drops. 

This is a somewhat peculiar prescription. On adding the 
morphine to the oil it will be found that it sticks to the sides 
and bottom of the bottle, and if dispensed in this way the 
patient would get no morphine. The way one druggist dis- 
pensed it was by adding to the oil an approximately equiva- 
lent quantity of oleate of morphine. A more eligible method 
would be the following: Dissolve the morphine in a little 
water, add a few drops of olive oil and a few grains of pow- 
dered acacia, rub until emulsified, and incorporate the oil 
of turpentine. Direct the patient to shake the bottle well 
before using. 

199. Tr. Ferri Chloridi 3 ij 

Tr. Valerian. Ammon 3 vi 

30 drops three times a day. 
The aromatic spirit of ammonia employed in making the 
ammoniated tincture will precipitate the iron as ferric hy- 
droxide. It would be practically impossible to take the med- 
icine by drops or even by teaspoon, as the precipitate is very 
bulky and gelatinous. There is no way out of the difficulty. 

200. Hepar Sulphuris 5 i 

Liq. Hydrogenii Peroxidi J ij 

Aquae Rosae 3 ij 

S. : Lotion. Apply at night on gauze. 
I doubt whether this lotion, which is expected to beautify 
the complexion, has any virtue in it whatsoever. The liver 
of sulphur — or potassa sulphurata — is, as is well known, not a 
definite compound, but a mixture of all or of several of the 
following compounds: Potassium monosulphide, K 2 S; potas- 
sium trisulphide, K 2 S 3 ; potassium pentasulphide, K 2 S 5 ; potas- 
sium thiosulphate (wrongly called hyposulphite), K 2 S 2 3 ; 
and potassium sulphate, K 2 S0 4 . When dissolved in water, 
liver of sulphur yields an orange-yellow solution; on adding 



PRESCRIPTION INCOMPATIBILITIES 119 

peroxide of hydrogen, the solution becomes milky white. All 
the various sulphides become oxidized to sulphates; the per- 
oxide, of course, becomes reduced to hydrogen monoxide, i. e., 
water. The milky turbidity is due to the sulphur which pre- 
cipitates from the thiosulphate. 

201. Liver of Sulphur 10 grains 

Corrosive Sublimate 4 grains 

Rose water 4 fl. oz. 

This is a newspaper prescription, given by the newspaper 
doctor in reply to a request for a lotion to remove freckles. 
The preparation is worthless. On account of the various 
compounds of which sulphurated potassa consists, a number 
of reactions will take place. The chief reaction results in the 
formation of the black mercuric sulphide, which gives a black, 
dirty appearance to the mixture. 

202. Tr. Ferri Chloridi 3 ij 

Tr. Digitalis 3 j 

Glycerini 3 iv 

Aquae q.s. ad I iij 

On mixing the tincture of iron with the tincture of digi- 
talis a dark mixture results. This is due to the tannic acid 
in the digitalis combining with the iron to form iron tannate. 
Otherwise the prescription is all right. It is best to mix the 
tincture of iron with the other ingredients, and add the tinc- 
ture of digitalis last. 

203. Bismuthi Subnitr 5 j 

Argenti Nitratis gr. iij 

Sod. Bicarbon 3 v j 

Ext. Opii gr. iv 

Sacchari q.s. ad % iv 

M. et ft. pulvis. Sig: 3 j t.i.d. 

On standing, this powder becomes blackened on account 

of the reduction of the silver nitrate to silver oxide and then 

to metallic silver. The reduction is caused by the organic 

ingredients in the prescription. After a while there is no 



120 PRESCRIPTION INCOMPATIBILITIES 

silver nitrate left. If the physician insists on having the 
prescription put up just as written, he can have it. The 
silver nitrate should be first reduced to a fine powder, then 
carefully and slowly mixed with the bismuth subnitrate and 
the sodium bicarbonate; the extract of opium is to be thor- 
oughly incorporated with the sugar, and the powders mixed. 
This way of compounding will give the best results. The 
physician is mistaken if he expects the patient to get a uni- 
form dose of silver nitrate and extract of opium in each tea- 
spoonful of powder. 

204. Bism. Subnitr J j 

Argenti Nitr gr. vj 

Sod. Bicarbon 3 vj 

Ext. Opii Aquos gr. iv 

Syr. Aur. Cort 5 j 

Aquae q.s. ad J i y 

The ingredients in this prescription are practically the 
same as in the previous one, but the reactions are different. 
This is due to the fact that the mixture is a liquid. The 
silver nitrate has here three incompatibilities ; the opium, the 
syrup, and the sodium bicarbonate. When a solution of so- 
dium bicarbonate is added to a solution of silver nitrate the 
latter is at once completely precipitated as the white silver 
carbonate. In time the latter is reduced, as all silver salts 
are. There is another possible source of trouble in this pre- 
scription; it is between the bismuth subnitrate and the so- 
dium bicarbonate. When standing in a warm place, this 
mixture may explode, due to the liberation of carbon dioxide. 
This gas is evolved by the nitric acid, which is liberated from 
the subnitrate, and acts on the sodium bicarbonate. The 
equations are as follows: 

I. 2BiON0 3 + 2ILO = BiONOs + Bi ( OH) , + HNOs. 
II. NaHCo 8 + HN0 3 = NaNOs + C0 2 + H,0. 

In this prescription only about 2 drs. of the sodium bicar- 
bonate will be dissolved; 4 drs. remain at the bottom of the 



PRESCRIPTION INCOMPATIBILITIES 121 

bottle, together with the bismuth subnitrate and silver car- 
bonate. 

205. Quinin. Hydroekloridi 3 i 

Amm. Carbonatis 3 i 

Syr. Aurantii 5 ss 

Aquae Menthae Pip 3 iij 

Why physicians will prescribe a very soluble quinine salt 
and then precipitate it, is beyond comprehension. The qui- 
nine hydrochloride dissolves easily in the prescribed quan- 
tity of water; but the ammonium carbonate (like all alkaline 
carbonates) causes a precipitate of alkaloidal quinine. 

206. Campkorae gr. xxiv 

Morpkinae Sulph gr. vj 

Tr. Capsici 3 ss 

Aetkeris 5 ss 

S. : 20 drops every y% hour until attack is over. 

This prescription must not be dispensed, as written, under 
any circumstances. Only a small fraction of a grain of the 
morphine will dissolve; the rest, about 5% grn., will re- 
main in suspension. As the medicine is to be dropped, there 
is no possibility of adjusting the dose rightly. In one dose 
there may be only y s grn., while in the next there may be 1 
or 2 grn. As these doses are to be repeated frequently, there 
is altogether too much risk in dispensing the mixture. The 
reason why the morphine sulphate will not dissolve is because 
it requires about 700 parts of alcohol for solution, while in 
ether it is practically insoluble. In such cases it is usually 
possible to get out of the dilemma by employing the pure alka- 
loid instead of the salt. Unfortunately, this is not the case 
with morphine, for alkaloidal morphine requires 300 parts 
of alcohol and 4,000 parts of ether for solution. The acetate 
and the hydrochloride of morphine are much more soluble in 
alcohol than either the sulphate or the alkaloid ; but they 
would not do either, as the most that would dissolve of these 
drugs in the quantity of the menstruum given would be 



122 PRESCRIPTION INCOMPATIBILITIES 

from 3 to 3% grn. This is the way the writer would get 
over the difficulty: Make up the prescription without the 
morphine. As the physician evidently intended % g rn - of 
morphine per dose (in the physician's mind drop is always 
equivalent to minim ; 6 grn. divided into 24 doses make % grn. 
per dose), inclose 24 tablet triturates of % grn. each. At the 
same time send a note to the physician of about the following 
contents : 

"Dear Doctor: — Morphine sulphate is insoluble in tincture 
of capsicum and in ether ; I therefore left it out and send 24 
tablet triturates, *4 grn. each, instead, so that the patient may 
take one with each dose of the medicine. " I am sure the 
doctor would feel under great obligation to the pharmacist 
for pursuing such a course. 

207. Sodii Hyposulphit 3 ij 

Ac. Sulphur. Diluti 3 iij 

Glycerini 3 iv 

Aquae q.s. ad J iij 

S. : 3 j in cup of water, for rinsing mouth ; also internally, 
3 times a day. 

This prescription is incompatible, and cannot be dispensed ; 
either the first or second ingredient must be left out. 

Sulphuric acid decomposes the sodium hyposulphite (which 
is chemically sodium thiosulphate, and is now so designated 
officially) with the precipitation of sulphur and the evolu- 
tion of sulphur dioxide. The reaction is as follows : 

Na 2 S 2 3 + H.SQ* = Na 2 S0 4 + S + SO. + ILO. 

208. Pepsini Puri gr. vi 

Sodii Bicarbon gr iij 

Mf. pulv. Tal. Dos. xx. 

S. : One t.i.d. after meals. 

Pepsin is considered absolutely incompatible, therapeutic- 
ally, with sodium bicarbonate or any other alkali. The di- 
gestive power of pepsin is supposed to be destroyed by con- 



PRESCRIPTION INCOMPATIBILITIES 123 

tact with an alkali. Quite likely that this is the case. But I 
know many physicians who continue to prescribe pepsin with 
alkalies, because they claim they get good results from the 
combination. This reasoning is about as follows: The gas- 
tric juice always contains hydrochloric acid (and where it 
does not, like in cancer, then pepsin will be of little avail, 
anyhow), which neutralizes the alkaline medium, leaving 
the pepsin free to exert its proteolytic influence. But, some 
may say, experiments appear to show that the proteolytic 
power of pepsin, which has been in contact with an alkali, 
is lost forever; that even after neutralizing the alkali and 
rendering it acid, the pepsin refuses to work. To some 
physicians those experiments are not conclusive. A test-tube 
or a porcelain dish is very different from a living, secreting 
mucous membrane; and it is just possible that a pepsin, 
whose powers have become, so to say, dormant from treat- 
ment with some chemical, may suddenly awaken on coming 
into contact with such a membrane. While we do not regard 
"vital force" with the same superstitious reverence that was 
accorded it before the epoch-making year of 1828 — the year 
of Woehler's pregnant discovery — still we believe that not 
all vital phenomena can be or ever will be accounted for by 
strictly chemical processes, or expressed in chemical equa- 
tions; and he who sees no difference between a test-tube and 
a living stomach, has yet a good deal to learn. 

209. Pepsini 3 i j 

Resoreini 3 j 

Saloli 3 j 

Antiseptics are considered incompatible with pepsin, as 
inhibiting its digestive action. Whether they do so in the 
stomach is still sub judice. The salol will have no bad effect 
on the pepsin, as it is insoluble in the stomach and passes 
into the bowels, unchanged. The druggist should dispense 
this prescription without any questions, as it is only a case 
of (supposed) therapeutic incompatibility. 



124 PRESCRIPTION INCOMPATIBILITIES 

210. Sol. Fowleri 4.0 

Tr. Nuc. Vom 6.0 

Syr. Ferri Iodidi 50.0 

S.: Teaspoonful after meals. 

The potassium carbonate in the Fowler's solution will pre- 
cipitate the ferrous iodide as ferrous carbonate, which is 
itself rapidly decomposed. It will also tend to precipitate the 
strychnine and brucine in the nux vomica. The iron will 
combine with the ars'enite. As seen, there are three sources 
of incompatibility in this prescription. 

211. Aluminis 3 ss 

Ac. Tanniei 3 ij 

Glycerini 3 ij 

Aquae J ij 

S. : Shake well, and put teaspoonful in cup of warm water 
for gargling. 

The following note came with this prescription: "The 
mixture at once turned black; I made it up again with the 
same result. I made up similar combinations many times 
before, and it never happened. Can you explain this pecu- 
liar reaction?" The druggist was told that undoubtedly the 
alum contained an appreciable amount of iron. Examination 
of a sample of the alum proved the correctness of the sur- 
mise. Commercial alum is often contaminated with iron. 

212. Pepsini Puri 3 ij 

Ac. Hydrochl. Dil 3 j 

Tr. Gentian. Comp. 
Elix. Simpl. 

Aq. Menthae Pil aa J j 

S. : Cochlear parvum ter in die, post eibum. 

Are pepsin and, alcohol incompatible? This question is 
also answered differently by the chemists and by the clini- 
cians. The chemists say alcohol destroys the action of pep- 
sin; the clinicians say it makes no difference, as they get good 
results from the elixirs and wines of pepsin. Syme's experi- 



PRESCRIPTION INCOMPATIBILITIES 125 

ments seem to furnish a satisfactory reason for this difference 
of opinion. He has shown (Med. moderne, IX, p. 53) that 
the alcohol exerts its inhibiting action on the pepsin when 
both are in a glass or similar inorganic vessel. Something 
entirely different takes place, however, when the glass ves- 
sel is replaced by a moist animal membrane. The alcohol at 
once begins to diffuse through the membrane, and in a short 
time the pepsin begins to exert its solvent action on the al- 
bumen. In the experiments made, the albumen dissolved 
after two hours was nearly equal to the amount of albumen 
dissolved by pepsin in a medium containing no alcohol at 
all. He, therefore, concludes that pepsin is not incompatible 
with weak alcoholic media. 

213. Ferri et Ammon. Cit 3 i 

Potass. Iodidi 3 i 

Glycerini § ss 

Aquae ad J iij 

This prescription is all right. The iron and ammonium 
citrate has a neutral reaction and there is no liberation of 
iodine, even after standing for a considerable time. 

214. Tr. Ferri Chlor 3 ij 

Quin. Sulph 3 ss 

Aquae Creosoti 3 iv 

The quinine will dissolve in the water by the aid of the 
acid present in the tincture of iron ; but creosote with ferric 
salts produce a blue color, changing to a dirty green and 
brown, with a brown precipitate. 

215. Hydrarg. Chlor. Mitis' 

Sodii Chloridi L aa 0.3 

Pulv. Jalapae 
Tal. Dos. No. Decern. S. Unun mane nocteque. 

It is remarkable how sometimes a hasty statement made 
by an investigator after insufficient experimentation will gain 
circulation in the pharmaceutical press (and also in the med- 



126 PRESCRIPTION INCOMPATIBILITIES 

ieal), be quoted in the dispensaries, become incorporated in 
text-books, and gain credence as a well-established truth, 
without anybody taking the trouble to verify or disprove the 
statement. The above prescription is a case in point. For 
many years it had been held that to prescribe calomel and 
sodium chloride in the same powder meant death, or at least 
great bodily harm, to the patient, from the formation of 
corrosive sublimate. But is this so ? The author believes the 
prescription is perfectly compatible, and that no corrosive 
sublimate is formed. In twenty-four consecutive experiments 
he could find no more than insignificant traces of HgCl 2 , 
such as can also be found by triturating calomel by itself, or 
with water, or with some other inert substance like silica 
or kaolin. The author was among the first to establish this 
fact, and to teach his students to answer accordingly at exami- 
nations. The Latin signature means: "one powder morning 
and night." 

216. Hydrarg. Chlor. Corros gr. iv 

Potass. Iodidi 3 ij 

Ferri et Ammon. Citr 3 i 

Tr. Nucis. Vom 3 ij 

Tr. Cinchon. Compos ad % iv 

In many prescriptions we are confronted with a condition 
of affairs similar to the one in which a physician is when 
he is face to face with an incurable malady. He knows the 
trouble, but can offer no remedy. In the above prescription 
we know exactly what the trouble is, but we know at the 
same time that there is no way of improving it. The sources 
of trouble or incompatibility in this prescription are numer- 
ous. First of all it is well to be aware that ammonio-ferric 
citrate, while rapidly and completely soluble in water, is in- 
soluble in alcohol; and as compound tincture of cinchona is 
made with a menstruum consisting chiefly of alcohol, the salt 
will not dissolve. That is number one. Second, the corro- 
sive sublimate and potassium iodide precipitate the alka- 
loids of both the cinchona and the nux vomica. Even if there 



PRESCRIPTION INCOMPATIBILITIES 12 



lof each 3 i 

7 



were no nux vomica in the prescription, the precipitation of 
the cinchona alkaloids alone would make the mixture some- 
what dangerous; because it is well to remember that when 
HgCl 2 -f KI (iodohydrargyrate of potassium) precipitates 
an alkaloid, it becomes precipitated with it, in the form of 
a double salt. So that the mercury would be in the form of 
a precipitate, and the patient might get too much at one 
dose. A third cause of unsightliness would be in the black, 
inky color, produced by the action of the tannic acid pres- 
ent in the cinchona, bitter orange-peel, etc., on the ferric salt. 
In short, looked at from whatever point of view, the above 
is a bad combination, and it is advisable to refuse to dispense 
it. 

217. Bism. Subnitrate 
Liver of Sulphur 

Zinc Sulphate gr. x 

Lead Water J i 

Rose Water J iij 

A series of reactions will take place in this prescription. 
Zinc sulphate and lead water will produce a white precipitate 
of lead sulphate, and zinc acetate will remain in solution. 
The liver of sulphur, which consists of several potassium 
sulphides, will produce zinc sulphide (which is white), and 
with the lead the black sulphide of lead. Some black bis- 
muth sulphide will also be formed and there will also be 
a slight precipitation of sulphur. 

218. Ferri et Quin. Cit. Solubilis 3 ij 

Potass. Iodidi 3 iv 

Syr. Sarsap. Compos 3 ss 

Aquae Menth. Pip ad J iv 

The potassium iodide precipitates the quinine as quinine 
iodide; there is also a slight liberation of iodine, due to the 
fact that ferric salts, namely, those having an acid reaction, 
decompose potassium iodide with the liberation of iodine, 
while they become reduced to ferrous compounds. 



128 PRESCRIPTION INCOMPATIBILITIES 

219. Laetopeptini > 3 j 

Sodii Bicarbon 3 ss 

Hydrarg. Chlor. Mitis v gr. v 

Antipyrini gr. xv 

Sodii Phosphatis 3 j 

Caffein. Citratae gr. xv 

Sodii Bromidi 3 ij 

Ft. pulveres No. XII. 

The sodium bromide is incompatible with the calomel, con- 
verting it into mercuric bromide and mercurous oxide. The 
antipyrine is slightly incompatible with the calomel; the 
sodium phosphate when triturated with the citrated caffeine 
and the other salts liberates some of its water of crystalliza- 
tion, of which it contains 12 molecules and converts the whole 
into a pasty mass ; the small amount of HC1 contained in the 
lactopeptine and the citric acid in the caffeine will liberate 
some C0 2 from the sodium bicarbonate, etc. In short, this 
prescription is absolutely non-dispensable. 

220. Ac. Salicylici 3 v 

Sodii Bicarbonatis J iss 

Aquae Menthae Pip 3 iij 

"On putting the ingredients in a mortar, considerable ef- 
fervescence was noticed, but when the effervescence was over, 
a white powder remained, which no amount of rubbing or 
shaking could dissolve. What was the powder? Was it a 
new compound or was it the salicylic acid?" Thus runs the 
tale of one of my correspondents. No, the powder was neither 
a new compound, nor was it the salicylic acid. It is true, 
salicylic acid is but very slightly soluble in water; but in 
the presence of sodium bicarbonate and water a chemical 
action takes place and sodium salicylate is formed. Sodium 
salicylate is soluble in less than one part of water. Five 
drams of salicylic acid will combine with three drams of so- 
dium bicarbonate (molecular weight of salicylic acid = 138, 
molec. weight of sod. bicarbonate = 84, which gives us prac- 



PRESCRIPTION INCOMPATIBILITIES 129 

tieally the proportions of 5 to 3) ; there are still left 9 drams 
of NaHCOg. Sodium bicarbonate being soluble in 12 parts 
of water, it would require 108 drams, or 13!/2 ounces, of water 
to dissolve the remainder of the sodium bicarbonate in this 
prescription. There are only 3 ounces of menstruum ; nearly 
an ounce will be used up for keeping the sodium salicylate 
in solution ; in the balance only about iy 2 or at most 2 drams 
of sodium bicarbonate will dissolve. There are still seven 
drams left undissolved. 

This solution will turn dark after standing for some time. 
All salicylates are likely to turn dark and especially so in 
the presence of an alkali. I have been frequently asked why 
physicians should prescribe such combinations and not order 
sodium salicylate instead. The reason is that experience has 
demonstrated that such fresh preparations are more acceptable 
to some stomachs than the regular sodium salicylate. One of 
the causes of this acceptability is the carbon dioxide with 
which the solution is saturated. 

221. Syr. Ac. Hydriodicf 
Aquae Oxygenii 
Glycerini 

Syr. Aurantii Cort : 
Aquae Menthae 

Aqua oxygenii is a synonym for hydrogen dioxide. 

This decomposes the hydriodic acid, liberating iodine, and 
becoming itself decomposed into water. The equation is as 
follows : 

2HI + H.O. = 2H>0 + L 

If there be an excess of dioxide the liberated oxygen may 
oxidize the hydriodic acid to a higher compound. 

222. Liq. Hydrogenii Dioxidi 5 i j 

Kali Hypermanganici gr. xxx 

Aquae Destill. 3 iv 

Peroxide of hydrogen is an antiseptic, and so is potassium 
permanganate. Hydrogen dioxide and potassium perman- 



aa I j 

, aa § iss 



130 PRESCRIPTION INCOMPATIBILITIES 

ganate are absolutely incompatible. The solution of potas- 
sium permanganate is decolorized by the peroxide, with the 
formation of a precipitate of manganese dioxide and potas- 
sium manganate. 

The chemical reaction may be represented by the follow- 
ing equation: 

2KMn04 + 2ILO2 = K 2 Mn04 Mn0 2 + 2ILO + 20 2 
Potass. Hydrogen Potassium Mangan. Water Oxygen 
Permangan. Dioxide Manganate Dioxide 

The peroxide of hydrogen usually containing a small quan- 
tity of acid for its preservation, a small quantity of man- 
ganous sulphate will also be found. The reaction is: 

2KMn04+ 5H 2 3 + 3ILS04= K 2 S0 4 + 
Potass. Hydrogen Sulphuric Potass. 

Permangan. Dioxide Acid Sulphate 

2MnS04 + 8H.0 + 50. 
Manganous Water Oxygen 
Sulphate 

Of course, the prescription should not be dispensed. 

223. Aconitini '. gr. j 

Div. in pil. No. 24. S.: One pill twice a day. 
The author received this prescription with a note asking 
whether the dose was too large. There is not a single drug 
or chemical in the entire range of the materia medica the 
dosage of which has caused so much trouble to physician and 
to dispenser alike as aconitine has; and this is due to the 
fact that there is no other drug which varies so much in 
strength as do various samples of aconitine. Of two samples 
of aconitine one may be many times stronger than the other. 
It is time for physicians and pharmacists to know that sub- 
stances like aconitine, digitalin, etc., are not absolutely dis- 
tinct entities such as potassium iodide or sodium bromide. 
The name of the manufacturer is of little importance when 
the common chemicals are ordered, but it makes all the dif- 
ference in the world in the case of aconitine or of digitalin. 
I always claimed that in ordering aconitine, the kind wanted 



PRESCRIPTION INCOMPATIBILITIES 131 

(whether amorphous or crystallized) and the name of the 
manufacturer should always be specified. Otherwise a dose 
might be prescribed which will one time produce no effects 
whatsoever, and the next time prove fatal or nearly so. In 
the last edition of "Hager's Handbuch" (1899, page 151) it 
is distinctly advised to buy aconitine preparations directly 
from the manufacturer "in original packages, having it 
stated exactly what quality the preparation is and what its 
maximum dose." 

Aconitine cryst. Merck, and aconitine Duquesnel, are prac- 
tically identical, and their dose may be stated to be from 
1-600 to 1-100 grn. Under no consideration would the writer 
prescribe or advise a pharmacist to dispense more than 1-100 
grn. of crystallized aconitine ; he may go as high as one 1-60 
provided he is sure that the physician is fully aware of the 
potency of the drug. The amorphous variety may be pre- 
scribed in larger doses. What answer was given to the 
inquirer regarding the above prescription? On looking into 
the medical directory, it was found that the physician who 
wrote the prescription belonged to the eclectic school; there 
was then no doubt that it was the eclectic resinoid powder 
that was intended. Of this the dose is from 1-24 to 1-12 grn., 
and as much as % grn. may be given. The druggist was 
thus advised, and subsequent inquiry from the physician 
proved that this was correct. 

224. Quinin. Sulph 3 i j 

Ac. Sulph. Dil q.s. 

Salieini 3 vi 

Syrupi 3 i 

Aquae ad J iv 

A correspondent writes that on mixing the quinine with 
the acid and some water he obtained a perfectly clear solu- 
tion, but on adding the salicin a precipitate formed at once. 
"What was the precipitate due to? Was quinine salicylate 
formed or was salicylic acid thrown out from solution by the 



132 PRESCRIPTION INCOMPATIBILITIES 

sulphuric acid?" Some people will dig very deep for a 
cause when the latter is as plain as daylight. No chemical 
reaction of any kind is formed between the salicin and the 
quinine or the salicin and the sulphuric acid; in fact, no 
precipitate of any kind is formed. What was considered a 
precipitate was simply the excess of the undissolved salicin. 
Salicin is soluble in about 28 parts of water; consequently 
only about a dram will dissolve in the menstruum of this pre- 
scription; 5 drams will be in suspension; it is this undis- 
solved portion that our correspondent mistook for a precipi- 
tate. 

225. Cocain. Hydrochlor gr. vj 

Quinin. Sulph. 5 gg 

Tannini j 

Menthol 3 i 

Aquae Rosae q.s. ad J vj 

S.: Use as a gargle. 

What possible benefit can a patient derive from using 
such a conglomeration? I am convinced that not only would 
he derive no benefit, but his condition would become aggra- 
vated. The cocaine would be precipitated, as cocaine tan- 
nate, which, being insoluble, would have no effect. The qui- 
nine would be present partly as quinine sulphate and partly 
as quinine tannate, both insoluble ; the menthol which is here 
in excessive dose is insoluble in water, and on reaching the 
fauces and pharynx in an undissolved state would prove 
intensely irritating; even the astringent effect of the tannic 
acid would be to some extent destroyed, as a part of it 
would be used up to form insoluble compounds with the 
alkaloids. In short, the combination is a worthless one; the 
patient would have fared much better if the physician had 
prescribed half a dram of tannic acid in 6 ounces of water. 
Had the prescription been for internal use there might yet be 
some shadow of excuse for putting it up; we would say: 
"Well, the gastro-intestinal juices will decompose the insol- 



PRESCRIPTION INCOMPATIBILITIES 133 

uble combinations, and their constituents will produce their 
effect." For a gargle, however, the prescription should not 
be put up. 

226. Boracis 3 iv 

Pulv. Aeaciae 3 i 

Aquae Rosae 5 i y 

S. : For external use. 

This is a well known incompatibility. If the borax is dis- 
solved in a portion of the water and the acacia in another 
portion and the two solutions are mixed, a thin, gelatinous 
precipitate will result which will make the mixture altogether 
unpresentable. There is no way of obviating the difficulty. 
It is an instance of true incompatibility. 

227. Sodii Boratis 3 ij 

Pulv. Aeaciae 3 i 

Syrupi 3 ss 

Aquae Menthae Pip ad 3 "J 

S.: Teaspoonful every 4 hours. 

The two principal ingredients in this prescription are the 
same as in the previous one. Nevertheless this prescription 
can be dispensed because it contains another ingredient, 
namely, syrup, which prevents the gelatinization of the aca- 
cia. The proper way to make it up is to dissolve the borax 
in the peppermint water, the acacia in the syrup and mix 
the two solutions. 

228. Aspirini gr. v 

Hexamethylenaminae gr. v 

Mf. caps. No. 1. Tal. Dos. xxiv. 
S.: One three times a day after meals. 

One druggist hesitated to dispense this prescription be* 
cause he had heard or read somewhere that aspirin was in- 
compatible with hexamethylenamin. This is nonsense. I 
have seen these capsules dispensed hundreds of times without 
any trouble. It is not necessary to triturate the aspirin and 



134 PRESCRIPTION INCOMPATIBILITIES 

the hexamethylenamin very vigorously; simply mix them 
lightly and fill the capsules. 

229. Atophan 

Urotropin aa 0.3 

Mf. Pulv. Tal. Dos. xii. 
One powder in glass of water. 

The same is true of this prescription. There is nothing 
incompatible between atophan and urotropin. The druggist 
need have no hesitation in dispensing the prescription. 

230. Sodii Boratis 3 iss 

Ac. Salicyl 3 i 

Glycerini 3 x 

Syrupi q.s. ad J iv 

The ordinary druggist will simply mix the borax and the 
salicylic acid with the syrup, overlooking the fact that all 
the salicylic acid is not soluble in the menstruum. The 
proper way to dispense this prescription is to dissolve the 
salicylic acid in a part of the glycerin by the aid of a gentle 
heat and the borax in the other half of the glycerin. The 
solutions are then mixed and the syrup added. Made this way 
a clear solution is obtained without any undissolved salicylic 
acid in suspension. Another way quite permissible would be 
to dissolve the salicylic acid in a small quantity of alcohol, dis- 
solve the borax in the glycerin by the aid of a gentle heat, mix 
the solutions and add the syrup. 

231. Liquor. Cresolis Compos J iv 

Hydrarg. Bichlor gr. vii 

Potass. Permangan 3 iv 

3 i in two quarts of water for douche. 

This prescription forms an incompatible mess. The reac- 
tions that take place in it are too numerous to mention. (1) 
The potassium permanganate is incompatible with the cresol 
solution. (2) The mercuric chloride is incompatible with 



PRESCRIPTION INCOMPATIBILITIES 135 

the cresol solution. (3) The potassium permanganate is in- 
compatible with the mercuric chloride, and (4) The mercuric 
chloride is incompatible with the cresol solution. The proper 
way to make up this prescription is not to make it up at all 
and to notify the physician. I know that it is not an ex- 
tremely pleasant thing to have to send around or to call up 
the physician and tell him that his prescription cannot be 
made up ; he generally gets ruffled. But in a case like this, 
nothing else is left to be done. The prescription is too in- 
compatible to be dispensed, and to leave out the potassium 
permanganate, for instance, might put the druggist into 
greater trouble with the physician than to attempt to explain 
matters beforehand. 

232. Sodii Salicyl 3 iv 

Urotropini 3 ij 

Spir. Aetheris Nitrosi 3 i 

Aquae 3 v 

The only difficulty with this prescription is that after a 
little while it acquires a dark color on account of the action 
between the nitrous ether and the salicylate of sodium. There 
is no incompatibility between the salicylate of sodium and the 
urotropin. 

233. Diuretini 3 i 

Potassii Iodidi 3 ij 

Hydrarg. Chlor. Corros gr. ij 

Aquae q.s. J iij 

S.: 3 i 4 times a day. 

This prescription is incompatible. The mercuric chloride 
and the potassium iodide, which as we know form iodohydrar- 
gyrate of potassium, will either at once or eventually precipi- 
tate the theobromin. If there was no mercuric chloride in 
the prescription it could be dispensed with a shake label. 
But it is rather risky to dispense a prescription which con- 
tains mercuric chloride as a precipitate. 



136 PRESCRIPTION INCOMPATIBILITIES 

234. Phenacetini 4.0 

Tr. Ferri Chloridi 8.0 

Elix. Simpl 30.0 

Aquae 30.0 

S. : Teaspoonful every 3 hours. 

While the therapeutic wisdom of prescribing phenacetin 
and tincture of ferric chloride in the same mixture may well 
be questioned, still there is nothing incompatible in the com- 
bination and the druggist need have no hesitation in dis- 
pensing it. The proper way is to rub the phenacetin by 
itself carefully in a mortar, then add the simple elixir grad- 
ually, then the tincture of iron and then the water. Under 
certain circumstances a red color may result from the action 
of the phenacetin on the tincture of iron. 

235. Protargol 2.0 

Aquae 100.0 

S. : For external use only. 

There is of course nothing incompatible between protargol 
and water, but the way of dispensing a prescription contain- 
ing protargol makes quite a difference. If you put the pro- 
targol in a mortar and begin to rub it with water you will 
get lumps. The same thing will happen if you put the pro- 
targol in a bottle and fill it with water and shake it. There 
is only one way of making a protargol solution properly, and 
that is to measure the prescribed quantity of water in a grad- 
uate, and sift the protargol, i. e., spread it over the water 
with a sifting motion, and let it stand until dissolved. A 
clear solution is then obtained. The addition of glycerin to 
the protargol to aid in the solution is not permissible. 

236. Ac. Citrici 50.0 gram 

Kali Carbonici q. s. ad saturationem 

Aquae 500.0 gms. 

S.: J ss quaqua nora secunda. 

A druggist from Milwaukee sends in the above prescription 
and asks for a thorough, clear explanation. He writes that 



PRESCRIPTION INCOMPATIBILITIES 137 

he gets many such and similar prescriptions and is sorely- 
puzzled to know how much to take of the potassium carbonate 
or of any other ingredient. "What way is there to find out 
how much of one substance it takes to saturate another ? Is 
there an easy rule, by which one can always go ? I have never 
studied chemistry." The question that our correspondent 
brings up is a very important one. In a prescription like 
the above ignorance may lead to disagreeable results. If we 
add too little potassium carbonate, the solution will be in- 
tensely acid, so that the patient may not be able to take it. 
If we add too much, the result may be still worse, as potas- 
sium carbonate is quite poisonous. And still we cannot go 
here into a full explanation of the subject. To do so would 
mean to give an exposition of the principles of chemistry. 
We can only give an outline of the method of arriving at the 
solution of such and similar problems. The equation between 
citric acid and potassium carbonate is as follows: 
2ILCeH 6 07 + 3K a CO* = 2K 3 C6H 5 Ot + 3CO* + 3ILO 

That is, 2 molecules of citric acid require for neutraliza- 
tion molecules of potassium carbonate. The mol. weight of 
citric acid is 210, of potassium carbonate, 138. Twice 210 
equals 420 ; three times 138 is 414. In other words 420 parts 
of citric acid require 414 parts of potassium carbonate, or 
almost part for part. In this case it will be quite proper 
to take 50 grams of potassium carbonate. 

237. Acidi Salieylici gr. xx 

Ferri Pyrophos gr. v 

Sodii Phosphatis 3 i 

Aquae q.s. ad J ss 

S. : For one dose. 
The appearance of a mixture prepared from the foregoing 
ingredients will vary according to the way it is compounded. 
The formula is one which originated in the New York Hos- 
pital, and the pharmacist recommended the following method 
of preparing the mixture: Dissolve the sodium phosphate 



138 PRESCRIPTION INCOMPATIBILITIES 

in water heated to the boiling point, and in the solution so 
formed dissolve the salicylic acid and ferric pyrophosphate, 
heat being applied if necessary to complete the solution. 

Made in this way the mixture assumes a beautiful claret 
color, perfectly clear and transparent. It probably owes its 
color to the formation of a slight amount of ferric salicylate 
which passes into solution. 

238. Liquor. Hydrogenii Dioxidi 3 iv 

Glycerini \ ij 

S.: 3 ij after each meal. 

Those who see incompatibilities where none exist have as- 
serted that hydrogen dioxide and glycerin are incompatible. 
There is absolutely nothing incompatible between the two 
ingredients and a mixture of them may be kept for several 
months without any fear of deterioration. We so stated in 
a previous prescription, but there is no harm in an occasional 
repetition. 

239. Ac. Carbolici 

Tr. Iodi aa gr. xv 

Muc. Acaciae 3 i 

Alcoholis (puri) 3 v 

A disagreeable looking mess. Mucilage of acacia spoils the 
combination without doing any good. It should be left out 
without any question. Without the mucilage the prescrip- 
tion is all right. 

240. Adrenalini Chlor % ss 

Argenti Nitratis gr. v 

Aquae 3 v 

S. : Inject 3 times a day. 

An absolutely incompatible prescription. The chloride of 
the adrenalin precipitates the silver nitrate in the form of 
silver chloride. The adrenalin also reduces the silver to 
metallic silver while the adrenalin itself is oxidized and be- 
comes worthless. An example of incompatibility which is 
beyond any hope of relief or improvement. The physician, 



PRESCRIPTION INCOMPATIBILITIES 139 

who evidently had to deal with a very congested urethra, 
perhaps one that bleeds on the injection of silver nitrate, 
tries to obviate the undesirable effects of this salt by using 
adrenalin. But he only spoils both chemicals. It he does want 
to get the effects of both the silver nitrate and the adrenalin 
chloride, the only way to do it is to make them up in two 
separate injections and tell the patient to use the adrenalin 
chloride solution, say five or ten minutes after the silver 
nitrate injection. The doctor orders "adrenalin chloride," 
but what he means, of course, is the solution of adrenalin 
chloride, 1 to 1,000. 

241. Potass. Bromidi 5 ss 

Potass. Citratis 3 i 

Spir. Chloroformi 3 iii 

Aquae ad J viii 

S. : 3 ss P er dose. 
The salts and the water precipitate the chloroform out of 
the spirit. May be dispensed with a shake label, but it is 
a disagreeable prescription. 

242. Ung. Zinci Ox 5 i 

Aquae Calcis J iii 

Mf. ung. 

The doctor orders to make an unguentum. It cannot be 
done. You cannot make an ointment from one ounce of 
zinc oxide ointment and three ounces of lime water. The 
proper way to dispense this prescription is to melt the zinc 
oxide ointment and mix it with the lime water in a bottle, 
shaking it well. That will make a nice thin cream. 

243. Spir. Carnphorae 3 ii 

Aquae Menth. Pip 5 iii 

3 i every hour. 

On mixing the spirit of camphor with the water the cam- 
phor will precipitate out. There is no way of obviating it 
except by making an emulsion. It would be better to order 
the two drams of spirit of camphor separately and tell the 



140 PBESCBIPTION INCOMPATIBILITIES 

patient to use five minims dropped in a teaspoonful or table- 
spoonful of water. Then the patient gets the proper dose 
each time. To dispense it the way it is written, the camphor 
may not be properly distributed and the patient may get 
unequal doses of the camphor in each teaspoon. To take 
the proper amount of camphor (twelve grains), dissolve it 
in some olive oil, add powdered acacia and make up an 
emulsion with peppermint water would be all right as far 
as suspending the camphor is concerned. But that would 
be taking toft many liberties with the prescription. 

244. Aluminis 3 i 

Boraeis 3 i 

Glyeerini 3 i 

Aquae ad J viii 

S.: Use as a gargle. 
"While borax with alum gives a precipitate of aluminum 
hydroxide, still this prescription may be dispensed. The 
borax is to be dissolved in the glycerin, the alum in the water, 
and the solutions mixed. 

245. Aspirini 5 ij 

Potassii Iodidi 3 iv 

Aquae 5 *9 

S.: Teaspoon as directed. 
It is claimed that aspirin with solution of potassium iodide 
is apt to decompose with the formation of hydriodic acid. I 
believe this is a purely theoretical consideration. I know 
a physician who has dispensed this prescription very fre- 
quently for rheumatism and there seems to be nothing what- 
ever the matter with it. 

246. Hydrarg. Chlor. Mit 0.± 

Kali Iodati 0.5 

M.f. pulv. No. i. Tal. Dos. lx. 

S.: One twice a day, for 3 days, then three times a 
day for 3 days, then 4 times a day. 
Most likely a small amount of mercuric iodide will form 



PRESCRIPTION INCOMPATIBILITIES 141 

from the calomel and potassium iodide. But as the dose of 
the calomel is in itself so small we need have no fear on that 
score. The prescription is in general a bad one. It is a bad 
practice to prescribe an insoluble substance with a soluble 
one. Potassium iodide is best prescribed with mercuric chlo- 
ride or mercuric iodide in solution. Also, in damp weather 
the powders are apt to become wet from the deliquescence 
of the potassium iodide. 

247. Ac. Hydr. Dil J i 

S. : gtt. x in water after meals. 

All that is wrong with this prescription is the way it is 
written. One cannot be certain what the doctor meant. Did 
he mean hydrochloric acid, hydrobromic acid or hydriodic 
acid? Hydr. means anything. And a physician who will 
persist in writing prescriptions so carelessly should be de- 
prived of his license for 24 hours for each offense. 

248. Quin. Bisulph 3 i 

Sodii Benzoatis 3 ii 

Aquae 3 * v 

S.: Teaspoonful 4 times a day. 

In this prescription we get a bulky precipitate of quinine 
benzoate. There is also some free benzoic acid. If instead of 
the quinine bisulphate we use quinine sulphate the precipitate 
will not be so bulky. Because quinine sulphate being only 
slightly soluble in water, only a small amount of quinine 
benzoate will be formed. 

249. Quin. Sulphatis 3 i 

Sodii Benzoatis 3 ij 

Aquae 3 iv 

See the previous prescription. The best thing is to rub 
up the quinine sulphate with one-half of the water, dissolve 
the sodium benzoate in the other one-half, and mix the two 
solutions. 



142 PRESCRIPTION INCOMPATIBILITIES 

250. Sodii Benzoatis 3 iv 

Aquae Calcis J iv 

S. : 3 i 3 times a day. 

The greater part of the sodium benzoate will dissolve. But 
there will be a precipitate of calcium benzoate. Of course the 
mixture will no longer contain lime water, the lime having 
combined with the benzoate to form calcium benzoate. The 
little calcium benzoate in precipitation is of no value and 
might as well be filtered out. As a matter of fact it would 
have been just as well for the physician to order the sodium 
benzoate dissolved in 4 ounces of plain water. If the physi- 
cian does not belong to that small type that gets ruffled at 
each remark, it would be best to notify him of the incompati- 
bility. 

251. Ac. Salieyl 3 i j 

Glycerini 3 ij 

Aquae q.s. ad J iij 

There is not enough glycerin and water here to dissolve 
the salicylic acid. Borax increases considerably the solubil- 
ity of salicylic acid. There are, therefore, two ways of dis- 
pensing the prescription : to rub up the salicylic acid with the 
glycerin and water, allowing as much to dissolve as will dis- 
solve and leaving the rest in suspension, dispensing the pre- 
scription with a shake label — or to add about one dram of 
borax, dissolving the borax and salicylic acid in the glycerin 
and water by the aid of heat. The prescription can then be 
dispensed as a clear solution. But whether the pharmacist 
has a right to add the borax without the physician's per- 
mission is a question which cannot be answered dogmatically. 

252. Potassi et Sodii Tartr 3 i 

Ac. Sulphurici Arom S iij 

Aquae Menth. Pip 3 ij 

S. : 3 ij 3 times a day after meals. 
The principal incompatibility here is between the sulphuric 
acid and the potassium and sodium tartrate. The sulphuric 



PRESCRIPTION INCOMPATIBILITIES 143 

acid decomposes the salt, potassium bitartrate precipitating. 
The oil of cinnamon and tincture of ginger (in the aromatic 
sulphuric acid) will also separate out, giving the mixture a 
cloudy appearance. 

253. Sodii Salicyl 3 iij 

Syrupi Limonis 3 i 

Aquae | iij 

The citric acid contained in the syrup of lemon will decom- 
pose a portion of the sodium salicylate, crystals of salicylic 
acid floating in the mixture. The prescription should be dis- 
pensed with a shake label. If the physician gives permission 
to filter out the precipitated salicylic acid that fact should 
be noted on the prescription so that in repeating the prescrip- 
tion the same procedure may be followed. 

254. Sod. Benzoatis 3 ij 

Syrupi Limonis J ss 

Syr. Ac. Citrici J ss 

Aquae J iij 

The remarks made in the previous prescription apply with 
full force to this one. Instead of salicylic acid precipitating 
we will have benzoic acid precipitated by the citric acid con- 
tained in the syrup of lemon and the syrup of citric acid. 

255. Pepsini Puri 3 iii 

Ac. Hydroeyan. Dil 3 iv 

Aquae ad 3 iii 

S. : 3 i after meals. 

If the pharmacist put up the prescription as written the 
patient would probably never take more than one dose of it. 
He would be dead very promptly after. Though the prescrip- 
tion calls very plainly for diluted hydrocyanic acid, there 
is no doubt that the physician meant diluted hydrochloric 
acid, that it was simply a slip of the pen. Ten minims of 
diluted hydrocyanic acid if of proper strength would very 
likely prove fatal. In this case the physician was called up, 



144 PRESCRIPTION INCOMPATIBILITIES 

he was full of thanks and of course he said diluted hydro- 
chloric acid was what he meant. 

256. Acetanilidi 3 ss 

Spir. Aetheris Nitrosi J ss 

Aquae | ss 

S. : 3 i q. 2 hr. until relieved. 
This prescription acquires a yellow color, gradually turning 
red. Some complex nitrous compounds are formed due to the 
reaction between the acetanilid and the spirit of nitrous 
ether. The compounds formed are not very, at all, poisonous 
and the prescription may be dispensed. But why physicians 
will persist in prescribing acetanilid in a liquid mixture is 
beyond understanding. The only proper way to prescribe 
acetanilid is in the form of powders, tablets or capsules. 

257. Acetanilidi 

Resoreini aa 15.0 

S. : For external use. 
When the two chemicals are rubbed together a moist mass 
or a liquid is obtained. By merely gently sifting the two 
powders they may be dispensed as a powder but there is 
always danger of their becoming liquid. Acetanilid should 
not be prescribed with resorcin. 

258. Acetanilidi 15.0 

Thymol 5.0 

Resoreini 5.0 

M.f. pil. No. xv. 

When thymol is rubbed with acentanilid a liquid is ob- 
tained. Acetanilid and resorcin also form a liquid or semi- 
liquid mass. The prescription is incompatible: it is impos- 
sible to dispense it as a permanent powder. 

259. Acetozone 3 i 

Aquae 3 iv 

S. : For external use. 
Acetozone is only very slightly soluble in water, only 1 
in 1560. Only a little over a grain will dissolve in four 






PRESCRIPTION INCOMPATIBILITIES 145 

ounces of water while here we have 60 grains. It is also 
well to remember that acetozone the way it comes on the 
market is mixed with one-half its weight of an insoluble 
absorbent powder. The proper way to use acetozone is to 
shake one part of acetozone with 1000 parts of warm water, 
let the undissolved portion subside and use the supernatant 
liquid. 

260. Pulv. Cretse Compos J i 

Elix. Vitrioli 3 i 

Aquae $ iv 

S. : J ss 3 times a day. 
This is an absolutely incompatible prescription which the 
merest tyro should understand and refuse to dispense. Sul- 
phuric acid (elixir vitrioli is aromatic sulphuric acid) will 
decompose the chalk with the liberation of a large amount of 
carbon dioxide and the formation of the insoluble calcium 
sulphate or gypsum. The prescription should not be dis- 
pensed, except by leaving out the elixir of vitriol. It is no 
use putting it in anyway because it becomes destroyed in the 
chemical reaction. 

261. Pulv. Rhei Compos 3 iij 

Ac. Hydrochlor. dil 3 ij 

Syr. Zingiberis 3 i 

Aquae ad J iv 

S. : 3 ii after meals. 

As we know, compound rhubarb powder contains mag- 
nesium oxide. This will combine with the hydrochloric acid, 
forming magnesium chloride. The physician should be in- 
formed of the incompatibility so that he may make the proper 
change in the prescription. 

262. Strychn. Sulph gr. %, 

Ext. Gentianae q.s. 

M.f. pil. No. xv. 

S. : One 4 times a day. 

This prescription is reproduced here because it caused the 



146 PRESCRIPTION INCOMPATIBILITIES 

writer several extremely anxious hours. Any pharmacist of 
any experience would understand that the strychnine sul- 
phate was meant to be divided into fifteen pills. But the 
boss was out when the prescription was presented and the 
junior clerk made it up, putting 14 of a grain of strychnine 
in each pill. The patient, a delicate young woman, took the 
pill at six o'clock and another one at ten. At about eleven 
she woke up with a very queer sensation, complaining that 
she was feeling very funny and that she thought she was 
dying. It took a very strenuous night of work with the 
administration of large doses of potassium bromide and 
chloral before the patient was out of danger. 

263. Sodii Glycerinophosph 3 ii 

Div. in pulv. No. xii. 

S. : One powder 3 times a day. 

It cannot be done. Sodium glycerinophosphate is either in 
the form of a semi-liquid mass or of very hygroscopic powder. 
It is impossible to dispense it in powder form. The only 
way to dispense sodium glycerinophosphate is in liquid form. 

264. Potassi Glycerinophosph 3 i 

Div. in caps. No. xii. 

One capsule 4 times a clay. 

It cannot be done. Potassium glycerinophosphate cannot 
be dispensed in capsules. It is almost a liquid or extremely 
hygroscopic powder. It can only be dispensed in liquid form. 

265. Calcii Glycerophosph. } 

Potassii " ^ , aa 3 i 

Sodii " J 

Div. in pulv. No. xx. 
S. : One powder in water 3 times a day. 

Of the three glycerophosphates the calcium is the only one 
that is not hygroscopic and can be dispensed in powder form. 
But the potassium and sodium glycerophosphates make the 
prescription an impossible one. 



PRESCRIPTION INCOMPATIBILITIES 147 

266. Ac. Benzoici 3 ij 

Aquae Calcis J viij 

S.: For external use. 
A portion of the benzoic acid will combine with the lime 
forming calcium benzoate, a small portion will dissolve with 
what is now plain water and the rest will remain undissolved. 
It 's an exceedingly poor prescription and the physician should 
be informed both of the incompatibility between benzoic acid 

kand lime water and of the slight solubility of benzoic acid. 



267. Ac. Gallici 5 n 

Ferri Sulph. pulv 5 "• 

Cupri Sulph "% ss 

Zinci Sulph 3 ss 

S. : 3 i in 2 quarts of water. 
As ferrous sulphate always contains some ferric salt there 
will be a black precipitate or black combination between the 
gallic acid and the ferrous sulphate. An unpleasant prescrip- 
tion, which a delicate female patient will not appreciate very 
much. 

268. Ac. Tannici 3 i 

Copperas J i 

Alum 3 i 

S. : 3 i in quart of water as directed. 

This powder dissolved in water will make a nasty inky 
mixture due to the action between the tannic acid and the 
copperas or ferrous sulphate. It will soil badly the under- 
wear and the linen, and to prescribe such a combination is 
equivalent to asking a patient, and a female one at that, to 
syringe herself with diluted ink. 

269. Agurin 5 i 

Sodii Salicyl 3 ii 

Syr. Limonis ^ \ 

Aquae % ii j 

S. : 5 i every two hours. 

Agurin is theobromine sodium acetate, which must not be 



148 PRESCRIPTION INCOMPATIBILITIES 

prescribed with, any acids or alkalies. The citric acid in the 
syrup of lemon decomposes agurin, precipitating' the theo- 
bromine. It also decomposes the sodium salicylate, precipi- 
tating some salicylic acid. 

270. Aluminis 3 i 

Boracis 3 i 

Aquae Chloroformi % vi 

S. : Use as a gargle or a spray. 
There will be a precipitate of aluminum hydroxid due to 
the reaction between the sodium borate and the alum. That 
precipitate might as well be filtered out, for it can do no 
good as a gargle or a spray. It couldn't be used in a spray 
anyway as it would be at the bottom as a precipitate, and if 
we shook it well and tried to use it it would clog the spray. 
The salts will also have a tendency to separate the chloro- 
form out of the chloroform water. It is a bad prescription 
and the physician should be so informed, of course, in a polite, 
diplomatic manner. 

271. Alumini et Pot. Sulph 5 v 

Aquae Calcis 3 viii 

S. : For external use only. 
Here we have a double incompatibility. The sulphate rad- 
ical of the alum will precipitate the calcium as calcium sul- 
phate and the hydroxide of the calcium will precipitate the 
alum as aluminum hydroxide. It is a bad prescription and 
the druggist is perfectly justified in dispensing five drams 
of alum dissolved in eight ounces of plain water. The lime 
water does no good, only mischief. 

272. Alypini gr. v 

Argenti Nitr gr. ij 

Aquae 3 i Vi 

S. : Use as injection. 
When alypin is prescribed without any specification, alypin 
chloride is dispensed, this being the usual combination in 
which alypin appears on the market. Of course the chloride 



PRESCRIPTION INCOMPATIBILITIES 149 

will give a precipitate with silver nitrate of silver chloride. 
If it is desired to prescribe alypin with silver nitrate the 
only way to do is to take alypin nitrate. That avoids the 
precipitation of silver chloride, though it does not entirely 
avoid the reduction of the silver nitrate to silver oxide and 
metallic silver in time. 

273. Alypini gr. vi 

Sol. Dobelli I iv 

S. : Use as spray. 

Dobell's solution having an alkaline reaction, alkaloidal 
alypin will be gradually precipitated. 

274. Piperazin gr. x 

Antipyrin gr. ii j 

M.f. pulv. Mitte pulv. tal. dos. xxx 

S. : One powder 3 times a day. 

"When piperazin and antipyrin are rubbed together a moist 
mass is obtained. Even piperazin itself being hygroscopic 
will become deliquescent when prescribed in powder form. 
The only proper way of prescribing the two chemicals is in 
solution. 

275. Argenti Nitratis , gT. i 

Boracis gT. x 

Aquae $ i 

S. : Swab mouth with solution. 

' A precipitate of silver borate will be formed, which ren- 
ders the prescription useless for therapeutic purposes. 

276. Argenti Nitratis , gr, v 

Sodii Boratis „ 3 ss 

Aquae 3 ii 

S. : For swabbing the mouth. 

The same reaction of course takes place in this prescription 
as in the previous one. The physician having failed to ob- 
tain any results from the first prescription thought it was 
due to the small dose of the silver and the borax and decided 



150 PRESCRIPTION INCOMPATIBILITIES 

to increase them in the next prescription. But this is just as 
bad, because the silver precipitating oat, the astringent and 
specific effect of the silver nitrate is lost and the prescription 
is worthless. The physician should be informed that silver 
nitrate and sodium borate are incompatible. 

277. Argonini gr. xi j 

Zinci Sulph gr. xviii 

Aquae destill J vi 

$.: Use as injection night and morning. 

Argonin is absolutely incompatible with zinc sulphate. A 
precipitate is formed. The only way to dispense this pre- 
scription is by leaving out either the argonin or the zinc 
sulphate. But of course the proper way is to inform the 
physician. 

278. Argonini gr. vi 

Ac. Tannici 3 i 

Aquae 3 i 

S. : For painting sore throat. 

The same remarks made in the previous prescription apply 
to this one. Argonin is incompatible with tannic acid, and 
the two should never be prescribed in the same mixture. 

279. Zinci Sulph gr. xij 

Plumbi Acet gr. xij 

Argonini gr. x 

Bism. Subnitr 3 ij 

Aquae 3 ^ 

S.: Shake well. Inject four times a day. 

Argonin is incompatible with zinc sulphate and with lead 
acetate. There is also an incompatibility here between the 
zinc sulphate and the lead acetate. The prescription is a 
bad one. If the doctor insists upon having it dispensed the 
way it is written, he may have it, but he certainly should be 
informed of the incompatibilities of argonin, and told that 
the proper way to prescribe argonin is just by itself. 



PRESCRIPTION INCOMPATIBILITIES 151 

280. Argyrol 3 i 

Zinci Sulph gr. xij 

Aquae % iij 

To be used as an injection. 

Like most of the organic silver compounds argyrol is in- 
compatible with zinc sulphate and the two should never be 
prescribed in the same mixture. 

281. Argyrol 3 ij 

Ac. Tannici 3 ss 

Aquae J i 

M.f. sol. 

S.: For painting the throat. 

Argyrol is absolutely incompatible with tannic acid and the 
two should never be prescribed in the same mixture. The 
proper way would be to leave out the tannic acid and to 
inform the physician. 

282. Hydrargyri Bichlor gr. ij 

Zinci Sulph gr. vi 

Argyrol 3 i 

Bism. Subnitr 3 ij 

Hydrastis Aquos J ss 

Aquae ad J vi 

S. : Use as injection. Shake well. 
Argyrol is incompatible both with zinc sulphate and with 
mercuric chloride. In fact mercuric chloride and argyrol 
form one of the finest examples of incompatibility. It might 
not be out of place to state here that mercuric chloride is 
one of the most efficient substances we have to remove stains 
of argyrol on the hands or linen. 

283. Sol. Donovani % i 

Strychn. Sulph gr. ij 

S.: gtt. x in water t. i. d. p. c. 

This is a dangerous prescription. The mercuric iodide and 
the arsenic iodide would precipitate the strychnine and the 
patient might get an overdose towards the end. 



152 PRESCRIPTION INCOMPATIBILITIES 

284. Liq. Arseni et Hydrarg. Iod 3 iij 

Quin. Hydrochlor 3 ss 

Strychn. Sulph gr. i 

Aquae ad 5 iij 

S. : 3 i ter in die p. c. 

The same remarks apply to this prescription. Both the 
quinine and the strychnine would gradually precipitate in 
combination with the arsenic and mercuric iodide. 

285. Liq. Ac. Arsenosi 3 iv 

Syr. Hypophosphit. Comp 5 iv 

S.: 5 i in water after meals. 

The hypophosphites, it is claimed, will reduce the arsenous 
oxide to metallic arsenic. Still it is not a dangerous pre 
scription to dispense, though it is better to notify the physi- 
cian of the incompatibility. 

286. Auri et Sodii Chlor gr. ij 

Liq. Potass. Arsenitis 3 i 

S. : gtt. x in water three times a day before meals. 

The potassium arsenite reduces the gold chloride to metal- 
lic gold. The prescription is considered an incompatible 
one. 

287. Sodii Benz 15.0 

Ac. Phosph. Dil 10.0 

Syr. Limonis 25.0 

Aquae ad 150.0 

One would think that even the oldest medical graduate who 
forgot or never knew any chemistry would not prescribe 
sodium benzoate with an acid. Still this was written by a 
rather prominent physician. It was probably an oversight 
on his part. The brightest physician will now and then make 
a blunder in prescribing. His mind is occupied with the 
diagnosis and prognosis of the case before him and he cannot 
be blamed if the fine chemical points are not always present 
in his mind. Of course it is the duty of the pharmacist to be 



PRESCRIPTION INCOMPATIBILITIES 153 

on the lookout and to call to the physician's attention any 
dangerous or impossible incompatibilities. 

288. Sodii Benzoatis , 3 iij 

Ac. Citrici 3 ij 

Aquae 3 iv 

S. : 3 i 4 x a day. 

The same is true of this prescription. The citric acid will 
decompose the sodium benzoate with the precipitation of 
benzoic acid. 

289. Mist. Rhei et Sodae 3 vi 

Ac. Hydrochlor. Dil 3 ij 

S. : Tablespoonful after meals. 

The hydrochloric acid will decompose the sodium bicar- 
bonate present in the mixture of rhubarb and soda, with the 
evolution of carbon dioxide and the formation of sodium 
chloride. Of course nothing dangerous will be formed here, 
but it would be a shame to dispense the prescription as writ- 
ten and the proper thing would be to inform the physician 
that one cannot eat his cake and keep it — that one cannot 
prescribe an acid and an alkali in the same mixture with the 
expectation of having both. If he wants the alkaline effect 
of sodium bicarbonate he should prescribe the mixture of 
rhubarb and soda without hydrochloric acid, and if he wants 
the effect of hydrochloric acid he should prescribe it without 
the rhubarb and soda. 

290. Mist. Rhei et Sodae 5 iv 

Pepsini Puri 3 ij 

S. : 3 i after each meal. 

This is a therapeutic incompatibility. Pepsin is supposed 
to become ineffective when in contact with an alkali. Of 
course nothing poisonous or dangerous or unsightly is formed 
here and the prescription may be dispensed. 



154 PRESCRIPTION INCOMPATIBILITIES 

291. Pepsini * 3 ij 

Ae. Hydrochlor ,....,. 3 ij 

Bism. et Amm. Citr. ..." 5 ss 

Aquae J iv 

The hydrochloric acid decomposes the bismuth salt, splits 
it up, bismuth citrate being precipitated. Bismuth and am- 
monium citrate should never be. prescribed with hydrochloric 
acid. 

292. Bism. Subnitr v VV. 3 iv 

Potass. Iodidi .** 5 iv 

Elix. Pepsini J i 

Aquae . : . . J iv 

S. : 3 i three times a day. ■ • ■ 

In this prescription there is a gradual formation of the 
red bismuth iodide. It may be -dispensed, but the patient 
should be cautioned beforehand'that the mixture will undergo 
a certain change in color. •• r ■. 

293. Bism. Subnitr 3 ij 

Ac. Tanniei 3 i 

Syrupi '.' 3 iv 

Aquae, q.s. ad ''. , J ij 

S. : Teaspoonful as required.- << 

In this prescription there will" be a gradual formation of 
the yellow tannate of bismuth.' It may be dispensed but the 
patient should be told of the' change that will likely take 
place in the mixture. 

294. Caffein. Citr 3 i 

"Sodii Brom 3 ij 

Strontii Brom „ , , 3 i 

Aquae Foeniculi 3 iij 

S.: 3 i every three hours. 

Here there will be a decomposition between the citrated 
caffein and the strontium bromide, with the formation of 
strontium citrate, which is insoluble in water and precipitates. 






PRESCRIPTION ^COMPATIBILITIES 155 

295. Caffein. Citr. efferves S i j 

S. : 3 i in water as required. 
This prescription was dispensed in a paper box and in a 
short time it became converted into a wet lumpy mass. Effer- 
vescent citrated caffeine is hygroscopic and should be dis- 
pensed in well stoppered bottles only. 

296. AiroJ £j 

Calomel , v ,7 aa 5.0 

S.: Apply externally. 
After a while, particularly in the presence of moisture, 
there will be formed some red mercuric iodide. Airol, which 
is chemically bismuth iodo-subgallate, rather readily yields 
its iodine, and this reacts on the calomel to form red mer- 
curic iodide. On a delicate surface like the prepuce this 
powder may prove quite irritating if a considerable amount 
of mercuric iodide is formed. 

297. Caffein. Sod. Benz 3 i j 

Ac. Hydrochlor. Dil 3 i 

Pepsini 3 ij 

Aquae 5 n J 

S. : 3 i after meals. 

The hydrochloric acid splitsi.up the double salt of caffeine 
and sodium benzoate, and besides decomposes the sodium 
benzoate, with the precipitation of benzoic acid. 

298. Bism. Salicyl 3 iv 

Pepsini puri 3 ij 

Ac. Nitrohydrochlor. Dil 5 ij 

Syr. Zingiberis ...".. 5 vi 

Aquae, ad 3$ 3 iv 

S.: 3 ii after meals. 

Bismuth salicylate is incompatible with acids. The acid 
decomposes the salt with the liberation of salicylic acid. The 
prescription should not be dispensed. The physician should 
be informed of the incompatibility and should leave out either 
the bismuth salicylate or the a,cid. 



156 PRESCRIPTION INCOMPATIBILITIES 

299 t Asaprol 3 ij 

Dermatol 3 iv 

Ac Nitrohydroehl. Dil J> ij 

Elix. Simpl J i 

Aquae ad J iij 

S. : Teaspoon in water after meals. 

Asaprol is bismuth betanaphtholate. Dermatol is bismuth 
subgallate. Both are incompatible with acids, which decom- 
pose them, splitting" off the betanaphthol in the. first instance 
and gallic acid in the second. In this prescription the acid 
should be left out. The physician should be notified so that 
he may prescribe the acid separately. 

300. Calcis Sulphuratae fi 3 i 

Div. in pulv. No. xij. T 

S.: One powder one hour after each meal. 

Crude calcium sulphide should; not be dispensed in powders 
because it is easily decomposed by the carbon dioxide of the 
air, liberating sulphuretted hydrogen. The proper way to 
prescribe it is in the form of tablets in well closed bottles. 

301. Spir. Camphorae .- gtt. x 

Aquae 3 iv 

... S.: 3 i per dose. 

On mixing the two, the camphor will precipitate. As there 
is but a small quantity of camphor, a much better way would 
be simply to use the official camphor water. 

302. Camphorae. 

Ac. Carbolici aa 3 ij 

S. : For external use. 

When camphor and phenol are rubbed together a liquid 
is obtained. In this case the mixture should be rubbed in a 
mortar until a perfectly clear solution is obtained. The 
solid phenol should be taken and not the liquid, as the lique- 
fied phenol containing as it does a certain amount of water 
makes a turbid solution with camphor. 



PRESCRIPTION INCOMPATIBILITIES 157 

303. Camphorae Monobrom gr. iij 

Chloralis Hydrati gr. v 

M.f. caps. No. 1. Tal. Dos. xxiv. 

S. : One on going to bed. 

When monobromated camphor is triturated thoroughly with 
chloral, a soft mass is obtained. The prescription, however, 
can be dispensed, but care must be taken not to triturate the 
jmonobromated camphor and the chloral too strongly. 

304. Carbo Anim 3 i 

Tr. Nuc. Vom 3 ss 

Tr. Cinchon. Comp 3 ij 

Tr. Zingiberis 3 i 

Aquae, ad 3 ™ 

S. : J ss t.i.d. p. c. 
Charcoal is supposed to precipitate alkaloids. Still the 
prescription may be dispensed and if well shaken there is 
little danger. It is not a pleasant mixture to take, but some 
physicians, and some patients, too, still think that the nastier 
a medicine tastes, the more efficient it must be. 

305. Chloral Hydrati 

Camphorae aa 3 ss 

S. : For external use only. 

When chloral and camphor are triturated together they 
form a clear liquid and the pharmacist should be careful not 
to dispense the prescription except in the form of a clear 
liquid. This injunction may seem superfluous, but for the 
fact that the writer only recently saw a druggist dispense 
the above prescription in a box in the form of a powder. He 
powdered the camphor all right, then powdered the chloral 
separately, mixed the two and put them in a box. Naturally 
a sticky mass was the result, which was entirely different from 
what the physician expected. 

On the other hand the writer knows of a case where the 
physician was both surprised and indignant when the above 
prescription was delivered in a bottle as a liquid. He was 



158 PRESCRIPTION INCOMPATIBILITIES 

sure that a mistake had been matte because be was under the 
impression that he would get • a powder, which was to be 
sprinkled over an ulcer. ^ * [ 

306. Chloral ^ p _' 

Camphor i'.\ aa 3 iij 

Phenol :r?i'i ; . 3i 

S. : Apply externally. '' f ' 

The remarks of the previous' prescription apply to this one 
as well. It might be added .that . the pure crystallized and 
not the liquefied phenol should- be used. 

307. Chloretone .".'.'..' 5 i 

Menthol gr. x 

Ac. Borici 5 ss 

M.f. pulv. For external use. 

When equal parts of chloretone and menthol are rubbed 
together a liquid is obtained. La this case, however, the pre- 
scription may be dispensed because it contains only 10 grains 
of menthol. The proper way wuld be to rub the chloretone 
with half the boric acid, the menthol with the other half 
and then mix the two powders. 

308. Hydrarg. Bichlor 1:5000 1 

Chinosol 4:1000 aa ^ U ' U 

S. : For external u$e. , 

Chinosol is incompatible witji "mercuric chloride and while 
both are excellent antiseptics .the two should never be pre- 
scribed together. ^ 

309. Potass. Chloratis ?A ! 3 ij 

Sodii Thiosulph ; |lfcU 3 i 

Glyeerini I 1 h";$ 3 ss 

Aquae .jltf. , ad J vi 

S. : 3 i four times a day internally; also to be used mixed 
with water as a gargle.:,** ■$ f 

In an acid solution sodium thiosulphate reduces chlorates 
with the liberation of chlorine and hydrochloric acid. This 






PRESCRIPTION INCOMPATIBILITIES 159 

prescription, however, may be dispensed, only care should 
be taken not to triturate the sodium thiosulphate with the 
potassium chlorate, as a little 1 - explosion might perhaps result. 

310. Potassii Chloratis .,". '. '. gr. iij 

Hydrarg. Chlor. Mitis gr. i 

Saechari .7 gr. v 

M.f. pulv. No. 1. Tal.' Dos. xij. 

S. : One 4 times a day. 
One druggist, who was also a physician, refused to dispense 
this prescription because he was taught or he had read or 
thought he had read somewhere that potassium chlorate will 
oxidize calomel to mercuric chloride. There is no foundation 
for this alleged fact and the prescription may be dispensed. 

311. Potassii Chloratis ...-.' 3 ij 

Hydrarg. Chlor. MitiV 3 i 

Bism. Subnitr 3 i 

M. f. pulv. For external use. 

The same may be said about this prescription. It may be 
dispensed without any apprehension. The potassium chlorate 
should be powdered separately, or should be used in fine pow- 
der and the three powders should be mixed lightly. 

312. Magnesii Sulph. 5 i 

Aquae Crotonis f 3 iv 

S. : J ss every hour. 

This prescription is presented here for its ' ' f unniness ' ' 
and the writer can vouch for the fact because he witnessed 
it himself. The prescription was presented to the boss, who 
handed it to the clerk, a very excellent prescriptionist, but 
not long in this country. He weighed out one ounce of mag- 
nesium sulphate, then went to the poison closet, took the 
croton oil, put eight drops in a mortar, put some magnesium 
carbonate in the mortar and began to add the water grad- 
ually, triturating briskly and getting ready to filter the mix- 
ture. When the boss asked him what he was doing, he said 
he was preparing Croton water, and he was used to preparing 



160 PRESCRIPTION INCOMPATIBILITIES 

"waters" extemporaneously by rubbing up two drops of the 
oil with an ounce of water. He did not know the expression 
"Croton water" which simply referred to New York tap 
water. He thought the physician wanted a "croton oil" 
water. He felt strengthened in his assumption by the fact 
that the prescription was meant as a cathartic and there 
was nothing more plausible than to have some croton oil and 
magnesium sulphate in the same mixture. 

313. Barii Sulph 5 ii 

S. : For doctor's use. 

There is no better illustration of the necessity for physi- 
cians writing out a prescription clearly, distinctly and fully 
wherever there may be the slightest possibility of misunder- 
standing, than the above prescription. It also shows the im- 
portance for a druggist to be up to date, to know what is 
going on in the line of materia medica and therapeutics, to 
be fully au courant with what physicians are apt to pre- 
scribe. The above simple prescription of just one line cost 
a man his life, caused the arrest of two physicians and of the 
druggist, and an endless amount of anxiety and expense to 
all three, besides the anguish and the suffering of the family 
of the dead man. 

Druggists have for many years been dispensing barium 
sulphide, which, as is well known, is used as a depilatory to 
remove superfluous hair. The druggist who received the 
above prescription did not know that of late we have been 
using very frequently barium sulphate (instead of bismuth 
subnitrate) in taking x-ray pictures of the gastro-intestinal 
canal. So when the druggist received the above prescription 
he promptly dispensed two ounces of barium sulphide. On 
receiving the bottle the physician emptied it, mixed it with 
the proper amount of water and made the patient drink it. 
The patient very soon began to feel badly and in an hour he 
was dead in spite of all that was done to save him. 






PRESCRIPTION INCOMPATIBILITIES 161 

Now, barium sulphate is harmless because it is insoluble 
in the stomach and intestines, is not absorbed by the system 
and is passed out with the feces. Barium sulphide is poison- 
ous and is not to be used internally except in very small 
doses. 

314. Calcii Chloridi 5 j 

Pulv. Cretae Compos 3 iij 

Aquae q.s. ad § ij 

S. : 3 i every 2 hours. 

The above prescription very nearly cost a little baby its 
life. Here there was no excuse for the druggist — it was 
plain ignorance. It was plainly written as above, calcii 
chloridi. But the drug clerk had never dispensed calcium 
chloride. He knew calx chlorinata and he took a dram of 
that and put it in the prescription. The baby, who was suf- 
fering with a severe bloody diarrhea, began to choke, became 
blue in the face, and it looked as if it would strangle any 
moment. Fortunately, however, after a severe attack of 
vomiting, it began to feel better. The mother ran to the 
druggist with the bottle and asked him if a mistake had not 
been made. He of course said no, but by a lucky accident 
the physician had just come into the store and hearing what 
the trouble was asked to look at the bottle. He smelled it 
and noticed a strong odor of chlorine, and then he told the 
druggist on the quiet behind the prescription counter that 
there must be some mistake, that calcium chloride has no 
odor of chlorine, that he prescribed it a number of times, 
and while it has not a pleasant taste it will not make any 
child choke and get cyanotic. With the help of the doctor 
the matter was straightened out and the child was not any 
the worse for it. In fact it seemed to make very favorable 
progress after that. It is possible that the chlorinated lime 
had a good disinfectant effect on the gastro-intestinal canal, 
but the infant could have lost its life. v 



162 PRESCRIPTION INCOMPATIBILITIES 

315. Collodii 

Tr. Iodi aa 3 ij 

There is nothing wrong with this prescription. It may be 
dispensed as written. 

316. Heroini gr. iv 

Ammon. Carbon 3 ij 

Syr. Pruni Virgin J i 

Aquae ad % iij 

S. : 3 i q. 3 hours. 

"When heroin is prescribed without any specification, heroin 
hydrochloride is usually dispensed. Heroin being an alka- 
loid will be precipitated by the ammonium carbonate and by 
the tannic acid of the syrup of wild cherry. Still I have 
seen it dispensed many times without any trouble, only it 
is safer to dispense it with a shake label. 

317. Adrenalin 5 ss 

Aqua? Hydrogenii Dioxidi 3 iijss 

S.: For external use. 

This prescription is absolutely incompatible and should not 
be dispensed. The adrenalin is completely decomposed or 
oxidized by the hydrogen dioxide. 

The physician writes for one-half ounce of "adrenalin." 
What he means of course is one-half ounce of the solution of 
adrenalin chloride 1 to 1000. It would be a mighty expensive 
prescription if it were to contain one-half ounce of pure 
adrenalin. 

318. Sol. Epinephrini 3 ij 

Hydrarg. Chlor. Corros. gr. i 

Aq. Destill % V\ 

Use as injection. 

Absolutely incompatible. The epinephrin is decomposed 
and the mercuric chloride is reduced to calomel and then to 
the metallic state. 



PRESCRIPTION INCOMPATIBILITIES 163 

319. Exalgin gr. v 

Phenacetin gr. v 

M.f. pulv. No. 1. D. T. D. xij. 

S.: One powder when required. 

When exalgin is triturated with phenacetin a moist or a 
soft mass is obtained. The prescription cannot well be dis- 
pensed in powder form. It can be dispensed by putting the 
exalgin and the phenacetin in separate powders and directing 
the patient to take one of each powders at a dose. It can 
also be dispensed in capsules by putting five grains of each 
of the ingredients in a capsule without any mixing or tritura- 
tion. 

320. Exalgini 

Phenacetini aa gr. iii 

Sodii Salieyl. 

Ac. Salieyl aa gr. v 

M. pulv. Tal. Dos. xxx. 
One 3 times a day. 

The first two ingredients in this prescription are the same 
as in the previous one and the same remarks hold good. We 
could make one powder containing the phenacetin, sodium 
salicylate and the salicylic acid, another powder containing the 
exalgin, and direct the patient to take one powder of each 
kind. 

321. Creosoti 3 i 

Guaiacol 3 iij 

M.f. pil. No. xxx. 

S. : One pill four times a day. 

It simply cannot be done. It is no use attempting to make 
pills containing two minims of creosote and six minims of 
guaiacol. The writer is well aware of the various maneuvers 
and excipients employed to make creosote and guaiacol pills. 
In fact he himself used to be an expert in this field and as 
a pharmacist was very proud of his ability to turn out in 
quick order two, three or five hundred creosote pills. By 



164 PRESCRIPTION INCOMPATIBILITIES 

using a little yellow wax, melted of course, also some pow- 
dered licorice or magnesia, etc., some sort of pills can be 
made. But all this is nothing but a waste of time and energy 
— it is a sho wing-off of useless virtuosity. It is the writer's 
opinion, his opinion as a physician and not a pharmacist, 
that no decent creosote pills can be made that would do the 
patient any good. Made in the form of pills the quantity of 
the creosote must be so small as to be hardly of any value, 
and if made to contain a considerable amount of creosote 
with very little excipient, the effect is apt to prove irritating 
and caustic. The proper way to administer creosote is in liq- 
uid form, properly diluted, or in the form of some of its 
chemical combinations. It would be a very fair and honest 
thing to enlighten the physician on this point, so that he may 
be discouraged in the future from ordering creosote or 
guaiacol in pill form. 

322. Creosote 

Guaiacol 

Creosotal 

Duotal 

Thiocol aa gr. v 

M. pulv. Tal. Dos. 200 
S. : One powder night and morning and after each meal. 
Of course this is a ridiculous prescription. The physician 
was very anxious to cure his patient and to give him at once 
all the anti-tuberculosis remedies that he had heard of. But 
he overlooked the fact, or perhaps he didn't know it, that 
creosote and guaiacol and creosotal are liquids and cannot 
be dispensed in powder form. Duotal, or guaiacol carbonate, 
and thiocol, potassium guaiacol sulphonate, are crystalline 
substances and can be dispensed in powders. There are no 
two ways about this prescription — the only thing the drug- 
gist can do is to notify the physician and advise him to dis- 
pense the first three ingredients in liquid form and the 
second two in powder form or to dispense them all in a liq- 
uid mixture. 



PRESCRIPTION INCOMPATIBILITIES 165 

323. Mass. Ferri Carbon gr. v 

Ac. Salicyl gr. iij 

M.f. pil. No. 1. Tal. Dos. XL. 

One ter in die p. c. 

These pills are likely to burst open. The salicylic acid de- 
composes the ferrous carbonate with the liberation of carbon 
dioxide, which gradually breaks up the pill. 

324. Ferri Carbon 

Sodii Carbon aa gr. v 

M. pil. No. 1. Tal. Dos. No. C. 
S.: One t.i.d. 
Ferrous sulphate and sodium carbonate are often prescribed 
to make fresh ferrous carbonate. The writer is strongly of 
the opinion that what the physician intended to write was 
ferrous sulphate. If he really meant ferrous carbonate, then 
there is no reason for having the sodium carbonate in. Of 
course the prescription can be dispensed, but in the writer's 
opinion it would be a kindness both to the physician and the 
patient to communicate with the former so as to make sure 
whether that is what he wanted. 

325. Strych. Sulph gr. i 

Quin. Sulph gr. xxx 

Sodii Glycerophosph 3 iss 

M.f. pil. No. 1. Tal. Dos. XXX. 

First of all you will notice the physician has made a mis- 
take in the directions. He writes tales doses, that is, he 
wants each pill to contain one grain of strychnine, 30 grains 
of quinine and 1% drams of sodium glycerophosphate. What 
he meant of course was to divide into thirty pills. Then each 
pill would contain 1-30 of a grain of strychnine, 1 grain of 
quinine and three grains of sodium glycerophosphate, which 
is quite proper. But even with that correction, the prescrip- 
tion is not a very good one, because it is pretty difficult to 
make satisfactory pills which should contain three grains of 
sodium glycerophosphate. But with a little magnesia, licorice 



166 PRESCRIPTION INCOMPATIBILITIES 

or althea, it can be managed. The pills, however, would be 
too large, and it would not be a bad idea to inquire of the 
physician if he would not prefer to substitute calcium 
glycerophosphate for the sodium glycerophosphate. 

326. Guaiacolis Crystall 15.0 

Div. in pil. No. L. 

Two pills three times a day. 
There is a pure crystallized guaiacol which can be made 
into pills, but it readily deliquesces and it is best to pre- 
scribe guaiacol, as stated in a previous prescription, in liquid 
form. 

327. Hydrarg. Ammon 5 i 

Sulphuris 3 ij 

Potassii Carbon 3 ss 

Adipis 3 i 

For external use. 

"When made up this ointment is yellowish white. But after 
a while it gets darker until it becomes gray or black. There 
is a reaction between the sulphur and the potassium carbonate 
and the ammoniated mercury, by which some sulphide of 
mercury and the black mercur-ammonium chloride is formed. 

328. Hydrarg. Chlor. Corros gr. iv 

Potassii Iodidi 3 iv 

Aquae J vi 

S. : 3 i 4 x a day. 

Of course this prescription is all right. It is one of the 
commonest prescriptions that a druggist has to dispense. 
Nevertheless, strictly speaking, it is incompatible because 
mercuric iodide is formed which redissolves in an excess of 
potassium iodide, forming the double iodide of potassium and 
mercury, the so-called iodohydrargyrate of potassium or 
M3ayer's reagent, which is such an excellent precipitant of 
alkaloids. 

I know of a case of a junior clerk who refused to dispense 
this prescription. "When he mixed the mercuric chloride 



PRESCRIPTION INCOMPATIBILITIES 167 

and the potassium iodide and noticed the formation of a red 
precipitate, he being a careful young fellow, was afraid to 
dispense it. He waited until the senior clerk came in, who 
explained to him that the precipitation was all right. 

329. Hydrargyri Chlor. Cor 3 ij 

Potassii Iodidi gr. ij 

Syr. Sarsap. Comp 3 iij 

Aquae % i 

S.: Teaspoon 3 times a day. 

An experienced druggist will have no difficulty with this 
prescription. He will notice at once that the doctor absent- 
mindedly turned the quantities of the two principal ingredi- 
ents around. He meant two grains of mercuric chloride and 
two drams of potassium iodide, but instead he wrote two 
drams of mercuric chloride and two grains of potassium 
iodide. Of course, made up the way the prescription is writ- 
ten, a teaspoonful of the medicine would kill the patient. I 
am personally of the opinion that he made the same mistake 
with the syrup and water, that he really meant one ounce 
of syrup and three ounces of water. But as it is of little con- 
sequence whether one ounce or three ounces of compound 
syrup of sarsaparilla is dispensed, the quantities of the last 
two ingredients may be dispensed as written. 

330. Hydrarg. Bichlor gr. i 

Liq. Fowleri 3 ss 

S. : gtt. viii in water after meals. 

This prescription is incompatible. The mercuric chloride 
is reduced to calomel and to metallic mercury, while the 
arsenite is changed into arsenate. The prescription is in- 
compatible and should not be dispensed. 

331. Hydrargyri Chlor. Corros gr. iv 

Aquae Calcis % iv 

S.: For external use. 

This prescription, while chemically speaking incompatible, 



168 PRESCRIPTION INCOMPATIBILITIES 

is all right. It forms the well-known yellow wash (Lotio 
Flava). When lime water is added to mercuric chloride the 
yellow mercuric oxide is formed. The reaction is as follows : 

HgCl 2 + Ca(OH) 2 = CaCl 2 + HgO + ILO 

332. Hydrargyri Chlor. Corros 3 ss 

Aquae Calcis J viij 

S.: Poison. For external use. 

In this prescription we also get a precipitate of the yellow 
oxide of mercury. But the prescription contains too much 
mercuric chloride and if it is to be applied to an infant, to 
a delicate surface, or to a raw surface, it should be done with 
great caution as great irritation of the skin may occur, or 
even an absorption of mercuric chloride, which may cause 
dangerous or toxic symptoms. 

333. Hydrargyri Chlor. Mitis 3 ss 

Aquae Calcis J vi 

S. : Apply externally every hour. 

This forms the well-known black wash which is a favorite 
application to chancroids, phagedenic ulcers and so forth. 
When calomel is added to lime water the black mercurous 
oxide is formed. The formula is as follows: 

2HgCl + Ca(OH) 2 = CaCl 2 + Hg 2 + H 2 

334. Ung. Iodi 3 ij 

Ung. Belladon 3 vi 

Hydrarg. Chlor. Mit gr. xx 

M.f. Ung.— S. Pile Ointment. 

It is not advisable to prescribe iodine (elementary iodine) 
and mercurial salts in the same prescription. Red mercuric 
iodide is apt to form, which is very irritating. Calomel in 
ointment form acts well in hemorrhoids. But red mercuric 
iodide even in very dilute preparations is painful and irri- 
tating, as it has proved in this case, 



PRESCRIPTION INCOMPATIBILITIES 169 

335. Hydrargyri Salicyl 10.0 

Aqu. Destill 100.0 

S.: Hg. Salicyl. 10%. 

Salicylate of mercury is insoluble in water, but is soluble 
in the halogen compounds of the alkalies, such as potassium 
chloride, sodium chloride, etc. The best way to make up this 
prescription is to dissolve the salicylate of mercury in 100 c. c. 
of a normal salt solution, i. e., 7-10 per cent, solution of chem- 
ically pure sodium chloride. 

336. Fluidext. Hyoscyami 3 ij 

Potassii Bicarbon 3 iij 

Fluidext. Tritici 3 iv 

Fluidext. Buchu 3 ij 

Aquae ad J iij 

The pharmacist or physician who has learned that alka- 
loids must not be prescribed with alkalies might be afraid 
to write or dispense the above prescription, thinking that the 
potassium bicarbonate would precipitate the alkaloids of 
hyoscyamus. But it so happens that the alkaloids of hyo- 
scyamus, i. e., hyoscyamine and hyoscine, are not precipitated 
by alkalies, and so the above prescription may be safely dis- 
pensed. It is a very common and useful prescription in 
cystitis. 

337. Ichthyol 3 i 

Zinci Sulph gr. xviij 

Aquae J vi 

S.: Inject 3 times a day. 

This prescription is absolutely incompatible and cannot 
and must not be dispensed. An unsightly precipitate is 
formed from the combination of the ichthyol with the zinc. 
The physician must be informed so that he may change the 
prescription or order the two ingredients in different injec- 
tions. 



170 PRESCRIPTION INCOMPATIBILITIES 

338. Iodoform! 3 i 

Bals. Peruviani 3 ij 

Adipis Benz J iss 

S. : Apply on lint. 

Certain statements have been made that iodoform is in- 
compatible with balsam of Peru. There is no foundation for 
these statements. The two go very well together and the 
prescription is perfectly all right. 

339. Tr. Iodi 3 ij 

Aq. Ammon 3 iv 

Linim. Saponis 3 iv 

S. : For external use. 

The iodine will combine with the ammonia to form ammo- 
nium iodide. Where there is sufficient ammonia to combine 
with the entire amount of iodine the color of the iodine will 
be destroyed and the preparation will be colorless because 
ammonium iodide is colorless. Whenever iodine is brought 
into direct contact with ammonia, there is also slight danger 
of iodide of nitrogen being formed, which is an explosive 
compound. But in small quantities, with which we generally 
have to deal in prescriptions, the danger is more a theoret- 
ical than a practical one. 

340. Ung. Iodi 3 ij 

Ung. Hydrargyri 3 vi 

M.f. Ung. S. Apply 3 times a day. 

The iodine combines with the metallic mercury and with 
the oxide of mercury which is usually present in the mer- 
curial ointment to form mercuric iodide. This is much more 
irritating than either iodine ointment or the mercurial oint- 
ment itself. As this prescription is often ordered for epi- 
didymitis and orchitis, and as the skin of the scrotum is very 
tender, it, i. e., the skin, is often completely removed by this 
ointment. It also burns very severely in some cases. If it 
does, the only thing to do is to wash it off with soap and 
warm water and then apply an emollient ointment like cold 



PRESCRIPTION INCOMPATIBILITIES 171 

cream or zinc oxide ointment, or some talcum powder or bis- 
muth subnitrate. 

341. Liq. Formaldekydi 

Liq. Hydrogenii Diox aa J viij 

S. : Use externally as directed. 

This prescription is absolutely incompatible. The formal- 
dehyde is oxidized by the peroxide of hydrogen to formic 
acid, and the H 2 2 is decomposed. An example of trying to 
get too much and of getting nothing. 

342. Lithii Citratis 3 ij 

Sodii Phosphatis J ij 

Aquae 3 iv 

S. : 3 ij in glass of water night and morning. 

In this prescription we get a precipitate of lithium phos- 
phate. Of course it may be dispensed with a shake label. 

343. Magn. Sulphatis 

Sodii Phosphatis aa J iv 

S. : 3 ij in glass of water on going to bed. 

Here we get a precipitate of magnesium phosphate. It 
would be much better to dispense the magnssium sulphate 
and the sodium phosphate in separate containers, and tell the 
patient to take a spoonful of each in half a glass of water, 
and drink them separately. It is better the reaction should 
take place in the stomach than in the glass. 

344. Menthol 3 i 

Alcohol 5 i 

Aquae 3 iv 

S.: Apply externally. 

The menthol dissolves rapidly in the alcohol, but on adding 
the water it precipitates. We get a cloudy mixture with 
the menthol precipitated out. Incompatible prescription, 
which, honestly speaking, should not be dispensed. 



172 PRESCRIPTION INCOMPATIBILITIES 

345. Tr. Ferri Chloridi 3 i 

Methyl Salieyl gtt. x 

S.: gtt. x in water after meals. 

Here one can see that the methyl salicylate has been pre- 
scribed for the express purpose of disguising the color of 
the tincture of iron. One-twenty-fourth of a drop of methyl 
salicylate (which is the dose in this case) can have no me- 
dicinal action. But as patients are familiar with ordinary 
tincture of iron and are apt to sneer at it, physicians often 
disguise its color either with a little antipyrine or sodium 
salicylate or any other salicylate. 

346. 01. Olivae 5 ij 

Menthol 3 i 

Glycerin 3 ij 

S. : For external use. 
Menthol is very soluble in olive oil as in all fixed or volatile 
oils. But the oil is not miscible with glycerin, contrary to 
the impression of many physicians. As stated elsewhere, 
many people, both lay and professional, regard glycerin in 
the nature of a fat and think it must be miscible with other 
fats. But it is not. This prescription does not make a very 
elegant mixture, but may be dispensed with a shake label. 

347. Menthol gr. x 

Petrolati liq 3 i 

Glycerin 3 i 

S. : Use with atomizer. 
The remarks of the previous prescription apply to this one 
as well. Menthol is very soluble in liquid petrolatum, but 
liquid petrolatum is not soluble in or miscible with glycerin. 

348. Pepsini 3 ij 

Pancreatini 3 ij 

Ac. Hydrochlor. dil 3 iv 

Syr. Zingib 3 i 

Aquae ad 3 iv 

S. : 3 i after meals. 
Pancreatin is considered to be absolutely incompatible with 



PRESCRIPTION INCOMPATIBILITIES 173 

hydrochloric acid or any other acids. Its activity is sup- 
posed to be destroyed. Pancreatin and pepsin in the same 
mixture are also supposed to be incompatible. But neverthe- 
less many physicians are prescribing this combir ^on, claim- 
ing they get good results from it and the pharmacist has no 
choice but to dispense it. 

349. Piperazinae 25.0 

Div. in pulv No. 25 

S.: One powder in glass of water 5 times a day. 
Piperazine is sometime quite hygroscopic and it is not 
advisable to dispense it in powder form. The proper way 
to dispense it is in solution. 

350. Cocainae Hydrochlor 0.6 

Morphin. Sulph 0.3 

Atropin. Sulph 0.02 

Petrolati Albi 25.0 

M.f. Ung. Apply after each defecation. 

The alkaloidal salts may be dissolved in a very small quan- 
tity of water and the solution incorporated with the white 
petrolatum. It would be still better if the physician had pre- 
scribed the pure alkaloids, because the pure alkaloids are as 
a rule soluble in solid or liquid petrolatum, while their salts 
are not. 

351. Phenol gtt. xv 

Arg. Nitr gr. v 

Aquae 3 v 

S. : For external use. 

The prescription is incompatible. The silver nitrate is re- 
duced to silver oxide and metallic silver. 

352. Salol gr. v 

Camphor gr. ij 

Antipyrin gr. iij 

M.f. pulv. No. 1. Tal. Dos. XL. 

This is a well known incompatibility. A soft mass or a 
moist powder is the result. 



174 PRESCRIPTION INCOMPATIBILITIES 

353. Protargol gr. xx 

Plumbi Aeet gr. xij 

Argenti Nitratis gr. v 

Aq. Destill 3 v 

To be used as injection. 

Absolutely incompatible. Protargol is incompatible both 
with silver nitrate and with lead acetate, and lead acetate is 
also incompatible with silver nitrate. 

354. Pyramidon 3 i 

Spir. Aetheris Nitrosi 5 iv 

Syr. Aurantii 5 i 

Aquae ad 3 ij 

S. : 3 ij every 4 hours. 

The solution acquires a blue or violet color. What we said 
about the incompatibility of antipyrin with spirit of nitrous 
ether applies here as well. The compound formed may not 
be poisonous, most likely is not, but it is better not to pre- 
scribe pyramidon with spirit of nitrous ether. 

355. Pyrogallol 25.0 

Potass. Permang 75.0 

S. : 3 i in basin of hot water for foot bath. 

This prescription is absolutely incompatible. The pyrogal- 
lol is oxidized, the potassium permanganate is reduced. 

356. Resorcini 

Quinin. Bisulph aa 0.2 

In caps, gelat. No. 1. Tal. Dos. xx. 

This prescription is all right. There is no objection to 
dispensing resorcin and quinine bisulphate in capsules, but 
the prescription would be incompatible if these two ingredi- 
ents were ordered to be dispensed in solution, as then we 
would get a precipitate. 

357. Aluminis 3 xij 

Sodii Boratis 3 xvi 

M. ft. pulvis 

S. : 3 ss in 2 quarts of water. 



PRESCRIPTION INCOMPATIBILITIES 175 

When powdered alum is rubbed with borax the mixture 
becomes moist due to the liberation of the water of crystal- 
lization. By mixing them gently this physical change may be 
prevented. The powder should be dispensed not in a paper 
box but in a wide-mouthed stoppered bottle. The really 
better thing would be to order the exsiccated alum instead of 
the ordinary powdered alum. 

358. Sodii Perboratis I i 

Aquae J xij 

S. : For external use. 
When sodium perborate is dissolved in water a chemical 
reaction takes place, hydrogen dioxide and sodium meta- 
borate being formed. The prescription may be dispensed, 
because that is what the doctor generally wants — a freshly 
prepared solution of hydrogen dioxide. 

359. Sol. Potass. Iod. Satur J i 

Sodii Thiosulphatis gr. v 

S. : gtt. x in milk t.i.d. 
This prescription is seen frequently. The small quantity 
of sodium thiosulphate has no medicinal action. It is added 
for the purpose of preventing the liberation of iodine. A 
solution of potassium iodide if kept for any length of time 
sometimes gets brown, due to the setting free of small quan- 
tities of iodine. The sodium thiosulphate combines with any 
free iodine that may be present in the solution and the solu- 
tion thus remains perfectly colorless. It is for the same 
reason that we sometimes add sodium thiosulphate to potas- 
sium iodide ointment. 

360. Potassii Iodidi 3 ij 

Sodii Iodidi 3 iij 

Spir. Aether. Nitr 3 vi 

Ess. Pepsini J i 

Aquae ad § vi 

S. : 3 i 3 times a day. 

The change in the color of this mixture will depend a good 



176 PRESCRIPTION INCOMPATIBILITIES 

deal upon the purity of the iodides and the spirit of nitrous 
ether. As a rule it gets brown after a short time, due to the 
liberation of iodine from iodides by the nitrous ether. 

361.' Spir. Ammon. Arom J ss 

Sodii Brom 3 ss 

Syr. Aurantii J ss 

Aquae 3 iij 

S. : 3 i as directed. 

This mixture becomes milky-turbid, for two reasons. Both 
the sodium bromide and the water liberate the volatile oils 
from the aromatic spirit of ammonia. 

362. Strychn. Hydroehlor 3 i 

Ac. Hydroehlor. Dil gr. i 

Elix. Peptenzyme 3 i 

Aquae ad J ii j 

S. : 3 i after meals. 

This prescription is all right. Hydrochloric acid is said 
to give a precipitate with strychnine hydrochloride, but this 
is true only of the strong hydrochloric, not of the dilute acid. 

363. Trional gr. x 

Chloral. Hydr gr. x 

M.f. pulv. No. i. Tal. Dos. hi. 

S. : One as required. 

Trional and chloral hydrate when rubbed together form a 
soft mass. 

364. Trional 
Sulphonal 

Urethane aa gr. v 

For one powder. Take at once. 

"When trional and sulphonal and urethane are rubbed to- 
gether, there is also a soft or semi-liquid mass. As the pre- 
scription calls> however, for one powder, to be taken at once, 
the ingredients may be put in wax paper without being mixed, 
and if taken at once there will be no trouble. 






PRESCRIPTION INCOMPATIBILITIES 177 

365. Sulphonal gr. xv 

Chloral. Hydrat gr. xx 

M.f. pulv. 1. Tal. Dos. vi. 

S. : Give one every hour until effective. 

When sulphonal and hydrated chloral are rubbed together 
a soft or moist mass is obtained. 

366. Agurin 15.0 

Spartein. Sulph 2.0 

Strychnin. Sulph 0.03 

Syrupi 30.0 

Aquae 200.0 

S.: Tablespoonful every 2 hours. 

Agurin, which is theobromine sodium acetate, is incom- 
patible with alkaloids, which it generally precipitates. It is 
also improper to dispense agurin with syrup or sugar. They 
decompose it. The dose of sparteine in this prescription is 
also too large, practically two grains to the dose. While in 
emergencies we sometimes have to give very large doses of 
this alkaloid, still it is best to make sure that the physician 
meant what he wrote. 

367. Diuretini 3 ij 

Liquor. Ferri et Amm. Acet 5 vi 

Aquae Menthae Piper 5 9 

S. : 5 ss 4 times a day. 
This prescription will acquire a violet color. Diuretin is 
theobromine sodium salicylate, and salicylates, we know, give 
a deep blue color with ferric salts. 

368. Thymol 3 i j 

Camphorae 3 iv 

Ac. Carbolici 3 i 

Ac. Borici § iv 

S. : M.f. pulv. S. : Apply externally. 

When thymol, camphor and carbolic acid are rubbed to- 
gether a liquid mass is obtained. By powdering the first two 



178 PRESCRIPTION INCOMPATIBILITIES 

ingredients separately, mixing the phenol with the finely- 
powdered boric acid and then mixing all the ingredients a 
serviceable powder may be obtained. 

369. Thymolis Iodidi 3 ij 

Amyli 5 i 

S.: Apply externally. 

It is stated that thymol iodide is incompatible with starch. 
It is claimed that some iodine may be liberated and combine 
with the starch to form iodide of starch. There is nothing 
to this criticism. First of all there is no liberation of iodine 
when the two are mixed, but even if there were no harm 
would be done. On the contrary it probably would be advan- 
tageous. For wherever thymol iodide is applicable, so-called 
iodide of starch is also applicable. So there is no harm in 
mixing thymol iodide and starch together. 

370. Thymol. Iodid. 

Calomel aa 3 ij 

Apply externally. 

When kept for a long time, or thoroughly triturated, or 
in the presence of moisture, red mercuric iodide may be 
formed ; but a little of it won 't hurt. I have personally pre- 
scribed thymol iodide and calomel a number of times as an 
application to chancroids and only with good results. 

371. Zinei Sulph gr. xij 

Ac. Tannici gr. xij 

Aquae 3 v * 

S.: Use as injection. 

This prescription is all right. Generally speaking, tannic 
acid is incompatible with zinc sulphate, zinc tannate being 
precipitated. But this occurs only when the two chemicals 
are in concentrated solution. It does not take place when 
the chemicals are in dilute solution. 



PRESCRIPTION INCOMPATIBILITIES 179 

372. Potass. Permang 3 gm. 

Thymol 5 gm. 

Alcohol 5 mils. 

Water to make 100 mils. 

Dissolve thymol in alcohol, permanganate in water 
and mix solutions. 
S. : Tablespoonful to 2 quarts of tepid water for foot 
lotion. 

This prescription was copied from a pharmaceutical jour- 
nal which in its turn had copied it from The Prescriber. The 
Prescriber is such a careful, competent journal that one can- 
not help being surprised at seeing this prescription recom- 
mended in its pages. Potassium permanganate is incom- 
patible with thymol and also incompatible with alcohol. After 
standing a while the potassium permanganate becomes com- 
pletely reduced and worthless. The quantities are copied cor- 
rectly, just as they appeared in the pharmaceutical journal. 
But to us they seem ridiculously small. Perhaps it is a typo- 
graphical error and the author of the prescription meant 3 
grams of potassium permanganate and 5 grams of thymol 
instead of 3 decigrams and 5 decigrams, respectively. 

373. Ac. Salicylici 3 ij 

Ac. Tannici 3 ij 

Aluminis § ij 

Kaolini J iv 

M.f. pulv. S. : Foot powder. Shake into stockings 
every morning. 

This prescription, as I happen to know, was prescribed for 
a very bad case of bromidrosis, that is, offensive sweating of 
the feet. The patient was told to put on every day a clean 
pair of socks, and preferably white socks, not colored ones. 
When the patient took off his socks the first night he was 
surprised and somewhat shocked to find both his feet and his 
socks dyed an inky black. The doctor was also surprised be- 
cause he expected no such thing; he expected the powder to 



180 PRESCRIPTION INCOMPATIBILITIES 

be practically white or slightly grayish from the tannic acid 
and the kaolin. The trouble with this prescription is this; 
Kaolin usually contains some iron. Alum also now and then 
contains a small quantity of iron. Salicylic acid with iron 
as you know gives a deep violet color, while tannic acid gives 
a bluish black color. To make the reaction complete a little 
water is generally necessary, which was furnished by the 
perspiration of the feet. The powder itself also very soon 
acquired a black color. 

374. Tr. Digitalis J ss 

Tr. Strophanthi J ss 

Sparteinae Sulph gr. xij 

Strychn. Sulph gr. ij 

Aquae ad J iij 

S.: Teaspoonful 4 times a day. 

This prescription presents no incompatibility, either phar- 
maceutical or therapeutic. On the contrary from a thera- 
peutic point of view, it is a "synergistic" prescription, that 
is, all the drugs act as cardiac tonics. But that is just the 
trouble with it. The dose of each ingredient separately, ex- 
cept perhaps of the sparteine, is not excessive, and may be 
administered without trouble. But the sum total of the 
amounts of these drugs, one fortifying the other, is excessive, 
and in this case the patient nearly died from one dose. It 
took several hours before he was brought out of danger. 

375. Antikamnia 
Antipyrin 
Phenacetin 
Acetanilid 

Phenalgin each 5 grs. 

Caffeine 2 grs. 

For one powder. Make a dozen. 
For neuralgia. 

This prescription was given to a woman who suffered from 
extreme neuralgia and she came pretty nearly being rid of 



PRESCRIPTION INCOMPATIBILITIES 181 

all her troubles after the first powder. About ten minutes 
after taking the powder she became cyanotic, the people 
around her claimed that she was as black as ink, and it took 
considerable stimulation with black coffee, brandy, hot bottles, 
etc., before she was brought around. 

376. Sol. Morphin. Sulph 3 i 

S. : 3 i as directed. 

In this case, of which I have personal knowledge, the pa- 
tient came very, very near losing his life. The druggist dis- 
pensed Magendie's solution, of which a teaspoonful was ad- 
ministered to the patient. Now as you well know, or perhaps 
not so well at the present time, there are two solutions of 
morphine. One contains only a grain to the ounce, while the 
other one, that is Magendie's solution, contains two grains to 
the dram. Of the old U. S. P. solution, which contains one 
grain of morphine sulphate to the ounce of water, a teaspoon- 
ful, containing one-eighth of a grain of morphine, is the 
proper dose. But of Magendie's solution, the proper dose 
is only four to eight minims, equivalent to one-eighth to one- 
quarter grain of morphine. A teaspoonful contains two 
grains, which is of course a fatal dose. It took a whole night 's 
work, with potassium permanganate washings of the stom- 
ach, rectal injections of strong black coffee, etc., before death 
was forced to loosen her grip on the patient. It might be of 
interest to add that the patient, who was a very sick person, 
and to whom the morphine was prescribed to allay the pains 
of pleuro-pneumonia, began rapidly to improve after his 
strenuous night in which he hovered between life and death 
for several hours. 

377. Hydrargyri Chlor gr. ^4 

Saceh. Laetis gr. v 

Piuv. No. 1. Tal. Dos. vi. 
S.: One every hour. 

The outcome in this prescription unfortunately was not so 
favorable It was made up by an unregistered drug clerk 



182 PRESCRIPTION INCOMPATIBILITIES 

who was very green in the business. He used one-quarter of 
a grain of corrosive sublimate to each powder. Now what 
the doctor wanted was one-quarter of a grain of calomel. 
Of course he should have written the prescription more care- 
fully but any competent druggist would know what to dis- 
pense. One-quarter of a grain of mercuric chloride is not 
such a terribly big dose and may be given to adults without 
trouble. But it so happened that in this case the patient was 
a newborn infant, only about two weeks old, and it died very 
promptly after the first powder. The druggist was arrested, 
it cost him a big sum of money, and he is not entirely over 
his troubles yet. 

378. Menthol gr. x 

Eucalyptol min. xv 

Zinei Sulph gr. x 

Albolene liq J ij 

Use with atomizer. 

This is an annoying but unfortunately too frequent pre- 
scription. The menthol and eucalyptol dissolve in the liquid 
albolene, but the zinc sulphate does not. No matter how 
finely you may powder it and incorporate it with the albolene, 
you cannot use it properly with an atomizer. It remains at 
the bottom. The doctor should be notified and advised to 
leave out the zinc sulphate or to prescribe it separately in 
an aqueous solution. 

379. Menthol gr. v 

Sol. Adrenalini , 3 ij 

Pinoleum 3 vi 

S. : Use as a spray. 

The menthol dissolves in the pinoleum, but the solution of 
adrenalin, which is an aqueous solution, does not mix. The 
water and oil do not mix and it is a bad prescription to be 
dispensed to use in a spray. 



PRESCRIPTION INCOMPATIBILITIES 183 

380. Hydrargyri Chlor. Corr gr. ij 

Pyrogallol gT. xx 

Petrolati § i 

Adipis Lanae 3 ss 

S. : Apply to scalp. 

Pyrogallol and mercuric chloride are incompatible. Mer- 
curic chloride is reduced and the pyrogallol is oxidized. Ex- 
posing the ointment to light and air also changes its color 
rapidly. 

381. Cocaini Mur 0.6 

Camphorae 2.0 

Chlorali Hydrat 2.0 

Apply to neuralgic spots. 
The proper way to dispense this prescription is to use the 
pure alkaloidal cocaine instead of the cocaine hydrochloride. 
It might be added that cocaine applied externally to the 
unbroken skin is perfectly useless, because it is not absorbed. 
Cocaine exerts its anesthetic properties only on mucous mem- 
branes or where the skin is abraded. 

382. Tr. Iodi 3 ij 

Ext. Goulardi 3 vi 

3 i to glass of water for external use. 

We get here a yellow precipitate of lead iodide. Strictly 
speaking, the prescription should not be dispensed, but as it 
is for external use, and is not going to do any harm, it may 
be dispensed with a shake label. 

383. Calx Chlorin 5 i 

Glycerini ^ i 

Aquae 3 i 

Apply full strength. 

Chlorinated lime is incompatible with glycerin. By mixing 
the two directly an explosion may occur. A complex chem- 
ical reaction takes place in which the glycerin becomes oxi- 
dized by the chlorine to oxalic and, eventually, carbonic acid. 
By rubbing the chlorinated lime with the water into a smooth 



184 PEESCRIPTION INCOMPATIBILITIES 

mixture and then adding the glycerin, the violence of the 
reaction is lessened,' but it is not entirely eliminated. 

384. Massae Valleti gr. v 

Kali Carbonici gr. v 

Stryehn. Sulph gr. 1/30 

Ac. Arsenicosi gr. 1/40 

M.f. pil. No. 1. Tal. Dos. LX. 

S. : One pill after meals. 

The potassium carbonate here is entirely unnecessary. It 
only increases the bulk of the pill and by the deliquescent 
action is apt to spoil it. Physicians are used to prescribe 
ferrous sulphate and potassium carbonate so as to have freshly 
prepared ferrous carbonate. And it is probably more a matter 
of habit than of actual necessity that the potassium car- 
bonate was ordered in this prescription. 

385. Europhen 15.0 

Amyli 45.0 

Apply externally to ulcer. 

Europhen is stated to be incompatible with starch because 
a little iodine may be liberated from the former which would 
combine with the latter to form iodide of starch. As stated 
in commenting upon another similar prescription, even if that 
were the case no harm would result. The so-called iodide of 
starch makes a very good vulnerary application. The pre- 
scription may be dispensed without any question. 

386. Iocamfen J i 

Aquae 3 iii 

S. : Apply externally on gauze. 

Iocamfen is not miscible with water and the prescription 
should not be dispensed. The proper method of using iocam- 
fen is either pure or mixed with oil. 

387. Europhen 3 i 

Ung. Aquae Rosae 3 i 

The borax contained in the cold cream may liberate a small 



PRESCRIPTION INCOMPATIBILITIES 185 

amount of iodine from the europhen. No great harm will 
result if it does. 

388. Airol 3 i 

Calomel 3 ss 

Aquae Calcis 3 iii 

For external use. 
Airol and calomel in the presence of moisture or water 
do not form a desirable combination, because some of the 
iodine from the airol may combine with the calomel to form 
red mercuric iodide. In this prescription there is another 
well known incompatibility, namely, the black mercurous 
oxide is formed from the action of the lime water on the 
calomel. 

389. Ess. Pepsini § i 

Ac. Hydrochlor. Dil 3 ii 

Magma Magnesiae q.s. ad 3 iii 

S. : 3 ii after meals. 

This prescription is absolutely incompatible. The hydro- 
chloric acid destroys the magnesia, converting it into mag- 
nesium chloride. This is one incompatibility. The other in- 
compatibility is between the magma magnesia and the es- 
sence of pepsin. Pepsin, as we know, is efficient or said to 
be efficient only in an acid medium. So if we leave out the 
hydrochloric acid the activity of the pepsin will be inhibited. 
If we leave in the hydrochloric acid the magma of magnesia 
is destroyed. The honest way to do is to inform the physi- 
cian. Where it cannot be done the prescription may be dis- 
pensed, because of course there is nothing poisonous in it. 

390. Aspirin 1 drachm. 

Sodium salicylate % drachm. 

Phenacetine ^2 drachm. 

Caffeine citrate 10 grains. 

Ammonium muriate 

Ammonium bromide aa l 1 /^ drachms. 

Chloral hydrate 1 drachm. 

Codeine sulphate 4 grains. 



186 PRESCRIPTION INCOMPATIBILITIES 

Tincture aconite, 
Tincture gelsemium, 
Tincture hyoscyamus, 

Tincture digitalis, fat-free aa 1 drachm. 

Syrup glycyr. compound q.s. 4 ounces. 

Directions: Two teaspoonfuls in water every four hours. 

This prescription, which is strictly bona fide and which 
appeared in a recent issue of the Bulletin of Pharmacy, is 
presented here merely as a curious example of polypharmacy, 
which was once very prevalent but which is now luckily al- 
most, though not entirely, obsolete. Now and then we still see 
such a prescription in a drug store, and as the doctor claims 
that he gets wonderful results from it, there is nothing left 
to do but to dispense it. 

391. Santonini gr. xx 

Calomel gr. viii 

Sacchari gr. xxx 

Div. in pulv. No. iii. 
One powder in the morning. 

This prescription is presented here merely for the overdose 
of santonin which it contains. "While we may often exceed 
the maximum dose given in the Pharmacopeia and in text- 
books on materia medica and therapeutics, still there is a 
limit, and where there is the least doubt it is better to be 
on the safe side. Here the druggist very wisely refused to 
dispense the prescription because he considered seven grains 
of santonin to a dose too risky. He telephoned to the physi- 
cian, and the latter apologized, saying that he meant to have 
the quantities divided into eight instead of three powders, 
but evidently he left out the Roman V. Divided into eight 
powders the prescription is all right, because the dose of 
santonin is then 2% grains, which is not an excessive dose. 



PRESCRIPTION INCOMPATIBILITIES 187 

392. Helmitol 3 i 

Potassii Bicarbon 3 ss 

Liq. Potassae 3 i 

PI. Ext. Buchu Ji 

PL Ext. Uvae Ursi 3 ss 

Aquae ad 3 vi 

S.: 3 i four times a day. 

Helmitol is chemically hexamethylenamine-methylene ci- 
trate, and it is incompatible with alkalies as it is incompatible 
with acids. As this prescription contains two alkalies, potas- 
sium bicarbonate and potassium hydroxide, the prescription 
is an incompatible one. The proper thing is to notify the 
physician. The incompatibility is not a dangerous one, and 
if the physician cannot be reached the prescription may be 
dispensed as written. True, the helmitol is decomposed, but 
the hexamethylenamine-tetramine is left. The patient may 
not derive very much benefit from the prescription, but what 
is the druggist to do? As long as nothing dangerous hap- 
pens, nothing particularly toxic, and he is unable to reach 
the physician and have him change the prescription, he has 
no other way out. 

393. Saliformin 3 ss 

Aquae 3 iii 

S. : 3 i four times a day. 

Saliformin is chemically hexamethylenamine salicylate. It 
is not good to prescribe it in water because it hydrolizes in 
water into its constituents. The proper way to prescribe it 
is either in tablets or dissolved in some elixir. 

394. Pepsini Optimi 3 i 

Betainae Hydrochlor 3 iii 

Aquae 3 iii 

S. : 3 i after meals. 

This prescription is ' ' perfectly all right. ' ' But the druggist 
who received it refused to dispense it. He thought that the 



188 PRESCRIPTION INCOMPATIBILITIES 

dose of betaine was excessive, and the reason he thought it 
was excessive was that he thought it was an alkaloid. And 
the reason he thought it was an alkaloid was that he confused 
it with and thought it was the same thing as betaeucain. 
Betaine is a colorless crystalline substance, containing about 
24 per cent, of absolute hydrochloric acid and is used in 
various digestive, disorders as a substitute for hydrochloric 
acid. Its average dose is eight grains, which corresponds to 
about eight minims of diluted hydrochloric acid. And the 
dose in this prescription is just right. Betaine is also known 
under its trade name Acidol. 

395. Chlorazene 3 ii 

Ac. Borici J ss 

Aquae Oii 

S. : Use externally as directed. 

Chlorazene, which is a trade name for dichloramine-T is 
incompatible with acids, even with such a weak acid as boric 
acid. And we might use this opportunity to state that in 
prescribing new remedies physicians should be particularly 
careful not to order them, in conjunction with other sub- 
stances. It is only if they are thoroughly familiar with all 
their possible incompatibilities, something which is not likely 
to be the case with the average physician, may they indulge 
in experimenting; otherwise they should prescribe them by 
themselves or just the way the authoritative textbooks advise. 

396. Chloramine-T 3 i 

Hydrogen Peroxide 5 ii 

Listerine 3 "- 

For external use only. 

The remarks of the previous prescription apply to this one 
as well. Why a physician who has a powerful antiseptic 
should want to combine it with several others is hard to 
understand, but such is human nature. Chloramine-T is in- 
compatible with hydrogen peroxide, with alcohol and with a 
number of other substances. 



PRESCRIPTION INCOMPATIBILITIES 189 

397. Halazone Tablets aagr.v No. xxx 

S.: One tablet in 2 quarts of water as a douche. 

Undoubtedly the physician in this case was mixed up. He 
heard or read that halazone was a powerful antiseptic or 
disinfectant and thought he would use it for medicinal pur- 
poses. Halazone is used only for the sterilization of water 
and appears on the market in tablets containing 1-15 or 1-30 
of a grain. The tablets usually contain also some sodium 
carbonate or borax and sodium chloride. One tablet contain- 
ing 1-15 to 1-30 of a grain of halazone is used for the ster- 
ilization of one quart of water. 

398. Hydrargyri Salicyl gr. iv 

Potassii Iodidi 3 iv 

Aquae 5 iii 

S. : 3 i four times a day. 
The physician who prescribed this prescription most likely 
thought that salicylate of mercury was soluble in water. Sal- 
icylate of mercury is practically insoluble in water and to 
dispense it the way it is written would be risky, because some 
of it might remain undissolved and it would be difficult to 
have the patient take an even dose. Mercury salicylate, how- 
ever, is soluble in the halogen compounds of the alkalies par- 
ticularly when the solution is warmed. The proper way 
would be to dissolve the potassium iodide in the water, heat 
the solution and then dissolve the mercury salicylate in the 
warmed solution. 

399. Salophen 3 i 

Natrii Bicarb 3 ss 

Div. in pulv. No. vi. 

Salophen is incompatible with alkalies in solution. But 
as this prescription calls for powders it is not incompatible 
and may be dispensed. 

400. Hexamethylenaminae 3 iv 

Sodii Acidi Pkosphatis, N. N. R % i 

Aquae § iii 

S. : 3 i three times a day. 



190 PRESCRIPTION INCOMPATIBILITIES 

As is well known, hexamethylenamine acts best when the 
urine is acid. And the best drug to make the urine acid is 
the acid sodium phosphate as described in the New and 
Non-Official Remedies; not the official sodium phosphate, 
which is chemically Na 2 HP0 4 but the acid phosphate or bi- 
phosphate, which is chemically NaH 2 P0 4 . But it is not ad- 
visable to prescribe the two in the same mixture. The acid 
sodium phosphate should be administered separately. It is 
not a chemical or pharmaceutical incompatibility and the 
druggist has no right to refuse to dispense this prescription ; 
but it is best the physician should know. 

Those who think that ''shot-gun" polypharmacy has gone 
entirely out of the fashion, may be somewhat shocked by 
contemplating the following prescription, written by a real 
live physician and reproduced in the Journal of the Ameri- 
can Medical Association. Here it is : 

401. 1£. Merck's Colchicin 

" Strychn. Phos aa grs. ii 

" Sod. iodid. 

" Sod. salieyl aa 3 x 

Tr. Belladonna 

" Bryonia alb aa 3 ii 

" Capsicum 3 i 

" Arnica mont. 

" Pulsatilla 

" Rhus tox aa 3 v 

" Phytoloeca 3 x 

" Cimicif. Rac. 

" Colchicum aa 3 xv 

Reed and Carnrick's Elix. Peptenzyme. 3 x 
M. S.: Take sixty (60) minims (drops) in a glassful of 
water, an hour after each meal. Take every 2 hours 
if very severe. 

We do not say that it did not do the patient any good (or 
harm), but it is a curiosity, anyway. 



PRESCRIPTION INCOMPATIBILITIES 191 

The following prescription is taken from the Journal of 
the N. A. B. D. (January 8, 1914) : 

"From an Illinois pharmacist comes the following breezy- 
note: 

A country physician moved into our city to build up a prac- 
tice. He knew me and we got quite chummy, and I told him 
that in order to be up to date he must write prescriptions and 
not do dispensing. 

He agreed, but said he did not know prescription forms, as 
he had never written one ; so I told him to write the best he 
could and I would make out what he wanted, all right. The 
first prescription was as follows, and I have it on file in its 
regular order: 

402. Quinine a little 

Strichnine not so much 

Iron a little more 

Make some capsules; take one every three hours. 

And the editor says: 

Comment is hardly necessary, only it shows, probably bet- 
ter than anything could, the looseness and criminal careless- 
ness displayed in the average dispensing doctor's office. " 

This is either a joke or a fib, or it is true. If it is a joke, 
it is in poor taste. If it is a fib, it is an insult to the medical 
profession. If it is true, it is a shame that such physicians 
should exist. 

But assuming that it is true that such physicians do exist, 
what is the moral of it ? The moral is plainly and distinctly 
and indisputably this : that physicians of such type, who are 
so incompetent to write a prescription, should not write pre- 
scriptions but should dispense ready made preparations from 
reputable manufacturing houses. I repeat, such physicians 
should not exist, and it is a shame that they should be per- 
mitted to practice, but it is a condition and not a theory that 
confronts us, and if such physicians do exist and they are 
permitted to treat patients, is it not better for the patients 
that they should dispense than to attempt to write prescrip- 



192 PRESCRIPTION INCOMPATIBILITIES 

tions when they do not know the doses and are not familiar 
with chemical and pharmaceutical incompatibilities? There 
is a very good reason for the vogue of good ethical pro- 
prietary preparations, and all the diatribes against dispensing 
by the physician, or against his prescribing of well thought- 
out, skillfully prepared proprietary pharmaceuticals will be 

in vain. — 

I present the following three prescriptions as specimens of 
herb recipes. They were written by an old herb doctor with 
an enormous practice. They were given to me by one of 
my patients whom that doctor had " treated' ' for over a 
year for impotence with these combinations. Practically 
every patient received the same prescriptions. 

403. Spanish Sarsaparilla % oz. 

Yellow Dock Root % oz. 

Skunk Cabbage Root }4 oz. 

Buchu }4 oz. 

Rhubarb Root V^ oz. 

Seullcap , V^ oz. 

Licorice Root V^ oz. 

Senna % oz. 

Blood Root Ys oz. 

Anise Seeds , % oz. 

Steep these in sufficient hot water for 3 hours to have 3 
pints of tea when strained. Add when cold 3 oz. Rye 
Whiskey. Dose 2y 2 tablespoonfuls 3 times a day, 15 minutes 
before meals or one hour after. 

404. Nerve Root X A oz. 

Mountain Ash Bark % ° z - 

Cleavers V^ oz. 

Rhubarb Root % °z. 

Elecampane Root ^4 oz. 

White Root ^ oz. 

Licorice Root -/4 oz. 

Seullcap ^4 oz. 

Anise Seeds % oz. 

White Ginger Root Vs oz. 



PRESCRIPTION INCOMPATIBILITIES 193 

Steep these in sufficient hot water for 3 hours to have 3 
pints of tea when strained. Add when cold 3 oz. Rye Whis- 
key. Dose 3 tablespoonfuls 3 times a day, 15 minutes before 
meals or one hour after. 

405. Blue Scullcap Vk oz. 

Mountain Ash Bark Vi oz. 

Princes Pine ^ oz. 

Sweet Flag Root V* oz. 

Culver's Root Vk oz. 

Snakehead Herb Vi oz. 

Marsjimallows a /4 oz. 

Rhubarb Root V± oz. 

Senna Vs oz. 

White Ginger Root Vs oz. 

Steep these in sufficient hot water for 3 hours to have 3 
pints of tea when strained. Add when cold 3 oz. Rye Whis- 
key. Dose 3 tablespoonfuls 3 times a day, 15 minutes before 
meals or one hour after. Rest 4 days, then renew one before 
this, rest 6 days and renew this one. 

Note that Rye Whiskey was an ingredient in each one of 
his prescriptions. 

406 Caffein. Citratis 3 ii 

Sodii Salicylatis 3 iv 

Aqua Destill 5 iv 

S.: 3 i every 3 hours. 

This prescription forms a precipitate ; and this precipitate 
has puzzled many pharmacists. Caffeine citrate is soluble in 
water, sodium salicylate is soluble in water, and if the rad- 
icals are exchanged the salts formed are still soluble, i. e., 
caffeine salicylate is soluble and sodium citrate is soluble — 
so why should there be a precipitate? The explanation is 
a very simple one. Caffeine "citrate" is not a true chemical 
compound, and for this reason it is called officially not caf- 
feine citrate but titrated caffeine. It is really a mixture of 
equal parts of caffeine and citric acid. Now, the citric acid 



194 PRESCRIPTION INCOMPATIBILITIES 

being free, it decomposes the sodium salicylate with the forma- 
tion of sodium citrate and salicylic acid, which latter, being 
but slightly soluble in water, precipitates. This incompati- 
bility can be easily avoided by using an equivalent quantity, 
which means just one-half, of pure caffeine. 

407. Iodi gr. x 

Potassii Iodidi 3 i 

Argyrol 3 i 

Aqua Destill J ii 

Use for painting throat. 

This prescription is absolutely incompatible. The argyrol 
is destroyed, silver iodide being formed. Silver iodide is 
therapeutically active, in fact sometimes too active, but that 
does not change the fact that the prescription must not be 
dispensed, because we no longer have argyrol in it. The 
physician's attention should be called to the incompatibility, 
and if he still wishes to have the prescription dispensed as 
written, it is his affair. 

408. Resorcini gr. xv 

Petrolati Liquidi 3 i 

M.f. sol. Use externally. 

Resorcin not being soluble in liquid petrolatum, it can be 
rubbed up and dispensed as a shake mixture. But a much 
better way is to dissolve the resorcin in a few drops of ether 
and then mix with the petrolatum. 

409. Resorcini ' 3 ii 

Glycerini J ii 

Apply externally with camel's hair brush. 

There is nothing whatever wrong with this prescription. 
One druggist refused to dispense it, saying that the two 
were incompatible and also that resorcin was not soluble in 
glycerin. There must have been some misunderstanding. 
Resorcin is perfectly soluble in glycerin and perfectly com- 
patible with it. 






PRESCRIPTION INCOMPATIBILITIES 195 

410. Strontii Bromidi 3 iii 

Sodii Bicarbon 3 ii 

Mist. Rhei et Sodae ^ iv 

S. : Tablespoonful after each meal. 

This prescription gives not only a precipitate but a copious 
effervescence. The precipitate is due to the formation of 
strontium carbonate. And where a soluble carbonate is used 
in combination with a soluble strontium salt that is all we 
get. But where a bicarbonate is used, we get also, besides 
the precipitate, an evolution of carbon dioxide which causes 
the effervescence. The following equation expresses the chem- 
ical reaction: 

SrBr 2 + 2 NaHCOa = SrCOa + 2 NaBr + C0 2 + H 2 

If the doctor insists upon the prescription being dispensed 
it may be dispensed, but it should not be put in the bottle 
until all the formation of gas has ceased, and the bottle in 
which it is put should be of larger capacity than the prescrip- 
tion calls for. Of course it should be dispensed with a shake 
label. 

411. Protargol gr. x 

Cocain. Hydrochlor gr. vi 

Aqua Destill 3 iii 

For injection. 

Here we will get gradually a white precipitate of silver 
chloride due to the interaction between the chloride of the 
Cocaine and the silver of the protargol. But the trouble can 
be easily prevented by using cocaine nitrate instead of co- 
caine hydrochloride. 

412. Acidi Sulphurosi 5 ii 

Aqua Hydrogenii Peroxidi 3 ii 

Use as a gargle. 

Each of the two ingredients is antiseptic, but when the 
two are mixed both are destroyed and a very weak solution 
of sulphuric acid is obtained. The reaction is expressed in 
the following equation: 



196 PRESCRIPTION INCOMPATIBILITIES 

H 2 S0 3 + H 2 2 = H 2 S0 4 + H 2 

This prescription is another example of trying to get too 
much and of getting nothing. 

413. Quininae Sulph gr. iii 

Aspirini gr. v 

M. f. caps. No. 1. Tal. Dos. vi. 
S. : One capsule every 5 hours. 

For some time the pharmaceutical journals carried the 
"important" information that quinine was incompatible with 
aspirin, because a very dangerous poisonous compound, quino- 
toxin, was formed, from which many deaths resulted. I put 
no credence in those reports at that time, and I do not now. 
As far as I know, the two chemicals are perfectly compatible. 
I have prescribed them and have seen them prescribed with- 
out any bad results. 

414. I. Tr. Iodi I iv 

S. : Two teaspoonfuls to quart of water. 

II. Tab. Hydr. Bichlor aa 0.5, No. xii 

So.: One in 2 quarts of water as directed. 

The young lady patient was ordered to use the two douches 
immediately following one another. She did so and expe- 
rienced a severe burning which lasted for over an hour. She 
was ordered to use these douches morning and night and, in 
spite of the severe burning produced by the first injection, she 
continued to use them for three or four days until the sore- 
ness and pain became unendurable. When she applied to 
another doctor for treatment he found the entire vaginal 
mucous membrane in a state of severe inflammation and so 
sensitive that the introduction of a speculum caused excru- 
ciating pain. 

The physician who had prescribed those douches with the 
best of intentions was evidently not aware of the fact, or 
it had slipped his mind, that iodine and mercuric chloride 
produce mercuric iodide, which is extremely irritating. When 
douches of iodine and of bichloride are ordered they must 






PRESCRIPTION INCOMPATIBILITIES 19* 

not follow each other too closely. Or a douche of plain 
water should be used after the iodine douche or after the 
bichloride douche so as to remove the chemical from the 
vaginal canal and to prevent the formation of mercuric 
iodide. 

415. Argenti Nitr 0.05 

M. f. pil. No. 1. Tal. Dos. eel. 

S. : Pil. un. q. in die. 

I reproduce the above prescription, which I dispensed 
dozens and dozens of times. The patient took several thou- 
sands of these pills with the result that his face became dark, 
then black in streaks, and finally assumed the color of a 
negro's; only it was not uniform, which made the case worse. 
Even while he was getting black he kept on taking the pills, 
neither he nor the physician assuming a causal relationship 
between the pills and the "turning negro." It was one of 
the severest cases of argyria that I have ever seen. When 
the patient finally discovered that his black color was not due 
to his disease, but to the medicine he sued the physician for 
damages. The patient was suffering with locomotor ataxia, 
and at that time silver nitrate was still considered a remedy 
for this disease. Before the case came to trial, however, the 
patient died and the case was dropped. 

416. Pepsin 
Pancreatin 
Taka Diastase 
Lactopeptine 

Ac. Hydrochlor. Dil each 2 dr. 

Mist. Rhei et Sodae 2 oz. 

Ext. Cascara Fl 2 oz. 

Elixir Peptenzyme 1 oz. 

Ess. Pepsin Fairchild 3 oz. 

S.: Tablespoonful after each meal. 

No prescription can demonstrate better the difference be- 
tween incompatibility and non-dispensability than the pre- 



198 PRESCRIPTION INCOMPATIBILITIES 

scription before us. That prescription is certainly incom- 
patible, incompatible chemically, pharmaceutical^ and thera- 
peutically. Nevertheless the physician insisted on having 
it dispensed just as written and said that if this drugstore 
did not dispense it as he wanted it, he would go somewhere 
else. He claimed that he got first-class results with it in 
the worst cases of dyspepsia, that his patients were satisfied, 
and that it was not the druggist's business to teach him or 
to make remarks about his prescriptions. And what are you 
going to do about it? You simply have to dispense it. As 
I said many times before, as long as there are no overdoses, 
no toxic precipitates, no danger of explosion, no irreparable 
deliquescence, and the mixture is presentable enough and 
fluid enough to be poured from the bottle, and the doctor in- 
sists upon having it dispensed as written, the pharmacist has 
no choice in the matter. After all, he is the servant and not 
the master of the physician. 

417. Sol. Fowleri 4.0 

Syr. Ferri Iodidi 100.0 

S. : Teaspoonful in water 3 times a day after meals. 
This prescription has been dispensed times without num- 
ber. The principal trouble is with the carbonate of potas- 
sium contained in the solution of potassium arsenite, which 
precipitates the iron as ferrous carbonate. Most likely some 
ferrous arsenite is also formed gradually. The precipitation 
can be avoided by using the solution of arsenous acid which 
is of the same strength as the solution of potassium arsenite. 

418. Tr. Nucis Vomicae 3 iv 

Tr. Gentianae Compos 3 i 

Aquae Menthae Piper 3 iii 

Sig. : 3 i t. i. d. p. c. 
The turbidity in this prescription is due to the fat con- 
tained in the nux vomica which is kept in solution in the 
alcoholic menstruum of the tincture of nux vomica, separat- 
ing on the tincture being mixed with a hydro-alcoholic and 



PRESCRIPTION INCOMPATIBILITIES 199 

aqueous menstruum. Of course the prescription may be dis- 
pensed as written. 

419. Bismuthi Salicyl 15.0 

Ac. Hydrocklor. Dil 10.0 

Ess. Pepsini 25.0 

Aquae 100.0 

S. : Tablespoonful after meal. 
Hydrochloric acid is incompatible with bismuth salicylate 
(the official salicylate of bismuth is not a true salicylate but 
a subsalicylate) ; a part of the bismuth is decomposed, bismuth 
chloride and then oxychloride being formed and salicylic 
acid separating out and floating in the mixture. The pre- 
scription may be dispensed, but it is a bad one. 

420. Bismuth. Salicyl 5 i 

Natrii Bicarbon 5 ii 

Mist. Rhei et Sodae 5 ii 

Aquae Creosoti 5 iv 

S. : 3 ss ter in die post cibos. 
Sodium bicarbonate and bismuth salicylate in an aqueous 
mixture will gradually develop carbon dioxide, which will 
either cause the popping out of the cork or bursting of the 
bottle. Sodium bicarbonate or potassium bicarbonate will do 
this with a number of salicylates, such as bismuth salicylate, 
lithium salicylate, or magnesium salicylate. The products of 
decomposition that are formed by sodium salicylate are bis- 
muth hydrocarbonate, carbon dioxide and water. Carbonates 
do not cause an evolution of carbon dioxide, only bicar- 
bonates. 



PRESCRIPTIONS WITHOUT CRITICISM 

The following prescriptions are presented without any 
criticism. Similar combinations have been analyzed in the 
preceding pages, and the student, pharmacist or physician 
can test his knowledge of incompatibilities by attempting, 
now and then, to criticize some of the prescriptions. Where 



200 PRESCRIPTION INCOMPATIBILITIES 

there is doubt or uncertainty in the reader's mind, a refer- 
ence to the Alphabetical Summary or the Index should help 
to solve the difficulty. 

421. Tr. Iodi 3 ii 

Argenti Nitr gr. x 

Aquae -^ 3 ii 

S. : Gtt. x in water 4 times a day. 

422. Sol. Adrenalini Chlor § ss 

Petrolati Liq J ii 

S.: Use as spray. 

423. Tr. Iodi 5 iv 

Aq. Ammon. Fort 3 iv 

Linim. Chlorof ormi 3 iv 

S.: Use with friction. 

424., Ac. Tannici 3 i 

Aq. Hydrog. Perox 3 iv 

Use as gargle. 

425. Argenti Nitrici 0.3 

Sol. Arsenic. Fowleri 5.0 

Aquae , 150.0 

S. : 3 i after each meal. 

426. Dobell's Solution i/ 2 pint 

Dioxogen % pint 

S. : For external use. 

427. Zinci Chloridi , 3 ii 

Aquae 3 iv 

S. : Use as injection twice a day. 

428. Zinci Oxidi gr. ii 

Aquae Destill 3 i y 

S. : Use as injection 4 times a day. 

429. Resorcin 1.0 

Bism. Subnitr 4.0 

Zinci Oxidi 6.0 

M. f . ung. 

S. : Apply night and morning. 



PRESCRIPTION INCOMPATIBILITIES 201 

430. Hepar Sulphuris 5 ii 

Zinci Sulphatis 3 ss 

Plumbi Acetatis 3 ss 

Aquae Rosae 3 vi 

S. : For external use. 

431. Lysol I iii 

S.: 3 i 3 times a day. 

432. Argenti Nitratis gr. v 

Glyeothymoline J iv 

S. : For external use only. 

433. Sol. Argenti Nitr., 10% I iv 

S. : One syringeful 3 times a day. 

434. Quin. Sulph 3 i 

Sodii Salicyl 3 iii 

Ac. Sulphur. Arom 3 i 

Elix. Glycyrrhiz 5 i 

Aquae 3 ii 

S. : 3 i every 4 hours. 

435. Sol. Ac. Carbolici, 10% J vi 

S. : Poison ! Apply externally. 

436. Potass. Permangan 3 i 

Ac. Phenyl 3 ii 

Aquae J vi 

S. : For external use only ! 

437. Peroxide 

Carbolic Acid, of each, proper quantity 

To be used as ordered. 

438. 01. Palmae Christi J i 

01. Menthae gtt. ii 

S. : Take at one dose. 

439. Zinci Chloridi 3 ii 

Aquae 5 iv 

S. : Use externally as directed. 



202 PRESCRIPTION INCOMPATIBILITIES 

440. Ung. Iodi J i 

Ung. Hydrargyri . § i 

S. : Apply 3 times a day. 

441. Chlorali Hydr 3 iii 

Potassii Brom 3 iv 

Aquae 3 ii 

S.: Tablespoonful at night. 

442. Chlorali Hydrati 3 iv 

Potassii Brom 3 iii 

Sodii Brom 3 vi 

Elix. Simpl J ii 

S. : One teaspoon at night. May be repeated in an hour if not 
effective. 

443. Quin. Sulphat gr. iii 

Sodii Salicyl gr. v 

M. f. pulv. 1. Make such powders xxiv. 
S.: One powder 4 times a day. 

444. Quin. Sulph 3 i 

Sodii Salicyl 3 iii 

Elix. Glycyrrhiz J i 

Aquae 3 ii 

S. : 3 i every 4 hours. 

445. Sol. Acidi Borici, 10% i 

S. : Apply on compresses. 

446. Ammonii Carbon gr. v 

Ammonii Chloridi gr. ii 

Hydrarg. Chloridi gr. 1/10 

For one caps. Make 12 capsules. 
S. : One 3 times a day. 

447. Ac. Picrici 
Aquae 

S. : For external use. Bush! 

448. Tr. Iodi 10.0 

Sol. Corr. Sublim. 1-1000 ...., ,..,. 100,0 

S, For external use only. 



PRESCRIPTION INCOMPATIBILITIES 203 

449. Acetphenetidini 3 i 

Antipyrini 3 i 

Spir. Aetheris Nitr 3 i 

Liq. Amm. Anis 3 ii 

Aquae, q. s. ad 3 i y 

450. Gran. Aeonitinae aa gr. 1/20 

No. xx 
S. : One every y 2 hour. 

451. Tr. Ferri Chloridi 3 i 

Tr. Cantharidis 3 i 

S. : Gtt. xii ter in die. 

452. Sol. Potass. Chlor., 10% 5 viii 

S. : Use as gargle. 

453. Ac. Carbol 3 i 

Collodion 3 iii 

S. : Paint with camel's hair brush around boil. 

454. Hydrarg. Bichlor gr. iv 

Sol. Potass. Permang., 25% 3 iv 

S. : Apply externally as directed. 

455. Atropinae Sulph gr. iii 

01. Olivae 3 iv 

S. : Caution ! Apply small quantity every hour until pain is 
relieved. 

456. Atropinae Sulph gr. iv 

Aquae Destill J iv 

S. : 3 i 3 times a day. 

457. Hydrarg. Chlor. Corros gr. iv 

Syr. Hypophosph. Comp J ii 

Aquae J i 

Elixir. Simpl J i 

S.: 3 i t. i. d. p. c. 

458. Potassii Iodidi 3 ii 

" Brom 3 iii 

Sodii Iodidi 3 ii 

" Brom 3 iii 



204 PRESCRIPTION INCOMPATIBILITIES 

Tr. Ferri Sesquichlor J i 

Aquae, q. s. ad, J viii 

S. : 3 14 times a day. 

459. Aquae Destillatae, U. S. P 1000.0 

Recente paratae, sterilizatae ! 

S. : Pro usu doctoris. 

460. Quin. Sulphat 3 ii 

Ac. Sulph. Dil., q. s. 

Tr. Ferri Chloridi 3 iv 

Syrupi Ji 

Aquae 3 iii 

S. : 3 i ter in die. 

461. Antipyrini 3 ii 

Aquae Destill § i 

S. : For external use! 

462. Hydrargyri Bichlor gr. iv 

Potassii Iodidi 3 ii 

Argenti Nitratis gr. viii 

Aquae % iv 

S. : 3 i 3 times a day. 

463. Phenol (100%) 3 i 

S. : For external use. 

464. Ichthyol 3 i 

Creosoti 3 ss 

Guaiacol 3 i 

Div. in caps. No. xxx. 

S. : Two capsules 3 times a day. 

465. Hydrarg. Chlor. Mitis 3 ii 

Ung. Iodi 3 vi 

M. f. ung. 

S. : Apply with friction 3 times a day. 

466. Sol. Magendie 3 i 

Tr. Lavand. Comp 3 iii 

Aquam, q. s. ad 3 ii 

S. : 3 i pr,o re nata. 



PRESCRIPTION INCOMPATIBILITIES 205 

467. Sol. Magendie gr. iv. 

S. : Gtt. viii as required. 

468. Potassii Iodidi 5 ss 

Syr. Ferri Iodidi J iii 

S. : 3 i in water 3 times a day. 

469. Potass. Permang. 3 i 

Glycerini 3 i 

Aquae 3 iii 

S. : For external application. 

470. Sodii Salicyl 3 ii 

Spir. Aetheris Nitr 3 i 

Ammon. Carbon 3 i 

Aquae 5 iii 

471. Ac. Arsenosi 0.06 

Strychn. Sulph 0.06 

Quin. Sulph 0.6 

Massae Ferri Carbon 6.0 

Div. in pil. No. xxx. 
S. : One 3 times a day. 

472. Chlorali Hydrati gr. v 

01. Theobrom gr. xx 

M. f. suppos. No. i. Tal. Dos. viii. 

S. : Insert two suppositories at night, one after the other. 

473. Pil. Hydrarg. Chlor gr. Y 8 

No. TYV 
S.: One t. i. d. after meals. 

474. Sulphuris 3 ii 

Bals. Peruv § ss 

Petrolati J i 

S.: Rub on at night. 

475. Sulphuris 3 ii 

Bals. Peruv 3 ss 

Adipis J i 

M. f. ung. 

S.: Apply at night. 



206 PRESCRIPTION INCOMPATIBILITIES 

476. Emulsionis Olei Morrhuae, 50% 

Spir. Frumenti aa J viii 

S. 3 ss after meals. 

477. Oleores. Cubebae 3 iv 

Fl. Ext. Buchu 3 vi 

01. Santali 3 ii 

Aquae J iv 

S. : 3 i 3 times a day. 

478. Hydrargyri Sublim gr. ii 

Potassii Iodidi 3 ii 

Ac. Nitrohydrochlor 3 ii 

Ess. Pepsini 3 i 

Aquae 3 ii 

S. : 3 i ter in die after meals. 

479. Trional gr. v 

Veronal gr. x 

Medinal gr. v 

Ft. pulv. 1. Tal. Dos. vi. 
S. : One on retiring. 

480. Morph. Sulph gr. ii 

Heroini gr. ii 

Dionini gr. ii 

Codeinae gr. vi 

Ammon. Mur 3 iss 

Syr. Tolut 3 i 

Aquae, q. s. ad J ii 

S.: 3 i 3 times a day. 

481. Tr. Ferri Chlor 3 iv 

Potass. Chloratis 3 iv 

Glyeer. Ac. Tannici 3 i 

S. : 3 i in water for gargling. 

482. Pilocarpinae Nitr 3 ij 

Bay Rum * , . . J viij 

S. ; To be used on scalp night and morning. 



PRESCRIPTION INCOMPATIBILITIES 207 

483. Potassii Brom I i 

Sodii Brom 3 i 

Ammonii Brom ^ ss 

Calcii Brom | ss 

Strontii Brom 3 ss 

Potassii Acetatis 5 i 

Sodii Citratis J i 

Lithii Citratis 3 i 

Aquae, q. s J xxij 

S. : 3 ss in glass of water on rising and on going to bed. 

484. Ichthyol, pure ^iv (•) 

S.: Teaspoonful 3 times a day after each meal. 

485. Tabloids Three Bromides B. W. and Co. No. C. 
S. : Three tablets in glass of water 4 times a day. 

486. Iodi 3 i 

Adipis Lanae 5 i 

M. f. ung. 

S. Apply externally night and morning. 

487. Zinei Sulphatis gr. v 

Mellis Boracis 3 ii 

S.: Use externally with swab. 

488. Creosotal 3 i 

Guaiacol 3 i 

01. Amygd. Express 3 ii 

01. Amygd. Amar gtt. v 

Div. in caps. No. xxx. 

S. : Two capsules 3 times a day. 

489. Arseni Trioxidi gr. 1/30 

Hydrarg. Bichlor gr. 1/16 

Quin. Sulph gr. i 

Massae Ferri Carbon gr. iii 

M. f. pil. No. 1. Tales Doses xl. 

S. : One pill 3 times a day after meals. 



208 PRESCRIPTION INCOMPATIBILITIES 

490. Sol. Potass. Arsen 3 iij 

Hydrarg. Bichlor gr. v 

Quin. Sulpb gr. xl 

Tr. Ferri Chloridi 3 vi 

Aquae, q. s. ad J v 

S. : 3 i ter in die p. c. 

491. Tr. Cinchonae 3 i 

Tr. Ferri Chloridi 3 i 

Tr. Cantharidis 5 ii 

S. : Gtt. xv t. i. d. in Vichy Water. 

492. Airol 3 iv 

Aquae 3 iv 

S. : Use as injection. 

493. Amnion. Benz 3 i 

Sodii Benz 3 iii 

Ac. Hydrochlor. Dil '5 ii 

Ess. Pepsini 3 ss 

Aquae I iij 

S. : 3 ii after meals. 

494. Quin. Sulph f 3 ii 

Tr. Digitalis 3 iv 

Liq. Ferri et Amnion. Acet J vi 

S. : 3 i quaqua hora tertia. 

495. Ext. Pituitary gr. 1 / li 

Ext. Thyroid gr. Y 2 ' 

Ext. Adrenal gr. i 

Ext. Orchitic gr. ii 

M. f . caps. No. 1. Tal. Dos. lx. 

496. Ext. Parathyroideae q.s. 

To make 60 capsules each to contain the usual dose. 

497. Apothesine, 10%, * 3 iv 

S. : For external use. 



PRESCRIPTION INCOMPATIBILITIES 209 

498. Salol 3 ii 

Spir. Aetheris Nitrosi § i 

Fl. Ext. Buchu 5 iv 

Aquae 5 iss 

S. : 3 i every 4 hours. 

499. Spirosal 5 ii 

01. Olivae . . J i 

S. : For external use. 

500. Sodii Thiosulph 3 ss 

Ac. Hydrochlor 3 ii 

Ess. Pepsini 3 i 

Syr. Zingiberis 3 i 

Aquae 5 vi 

S. : ^ ss after meals. 

501. Zinci Oxidi 1.0 

Camphorae 0.2 

Ung. Simpl 25.0 

M. f . ung. 

S. : Apply to the eyes once a day. 

502. Phosphori gr. 1/100 

Ext. Nuc. Vom gr. ^4 

Ferri Reducti gr. ii 

M. f. pil. 1. Fiant pil. lx. 

S. : One, night and morning. 

503. Liq. Plumbi Subacet J ss 

Ichthyolis 3 ii 

Olei Olivae J ii 

S.: For external use. 

504. Phenyl Salieyl 3 iii 

01. Amygdal 3 vi 

01. Amygdal. Am gtt. vi 

Aquae 3 iii 

S.: 3 i 3 times a day. 



210 PRESCRIPTION INCOMPATIBILITIES 

505. Sulphuris Loti gr. v 

Potassii Bitartr gr. x 

M. f . Tab. No. 1. Mitte C. 

S. : One tablet 4 or 5 times a day. 

506. Lupulini gr. iii 

Camphorae gr. iv 

M. f. pil. 1. Tal. Dos. xxiv. 

S. : One pill at 6 p. m. and one on retiring. 

507. Iodof ormi gr. xii 

Bism. subnitr gr. xxiv 

Div. in bacil. urethr. No. xii. 
S.: Insert one 4 times a day. 

508. Tr. Iodi 3 iv 

Ac. Carbolici 3 iv 

S. : Gtt. iv in water every 2 hours. 

509. Potassii Brom 3 ii 

Chloral 3 i 

Div. in suppos. rect. No. xii. 
Insert one at night. 

510. 01. Ricini 5 i j 

M. f. Emuls. 

S. : § ss every hour. 

511. Strychn. Sulph gr. ii 

Quininae Bisulph 3 ij 

Ac. Sulph. Arom 3 i 

Liq. Ferri et Ammon. Acet 3 * v 

S. : Two teaspoonsful 4 times a day. 

512. Bromof ormi 15.0 

Aquae 150.0 

M. f. Emuls. lege artis. 

S. : Teaspoonful every hour until relieved, then every 3 
hours. 

513. Chloral 

Camphor !ia 50.0 

S.: Apply externally. 



PRESCRIPTION INCOMPATIBILITIES 211 

514. Chlorali Hydrati 4.0 

Camphorae 2.0 

Syr. Tolutani 15.0 

Aquae 45.0 

S.: Cochlear parvum ter in die. 

515. Bism. et Ammonii Citratis 15.0 

Acidi Nitrici Diluti q. s. 

Ess. Pepsini 25.0 

Aquae 100.0 

S. : Tablespoonful after meals. 

516. Tr. Fern Mur , . . . 20.0 

Spir. Amm. Arom 15.0 

Syrupi 25.0 

Glycerini 25.0 

Aquae 125.0 

S. : Teaspoonful after meals. 

517. Argenti Nitr gr. xij 

Glycerini 3 i 

Aquae 3 i 

S. : Drop 3 drops into each eye morning and night. 

518. Sol. Magendie 5 i 

Ammon. Carbon 3 ii 

Syr. Ipecac 3 iv 

Syr. Pruni Virg. 3 vi 

Aquae, q. s. ad 5 iii 

519. Ac. Chromic 3 i 

Glycerini 3 iv 

Aquae 3 iv 

S. : Caustic. Use with caution. 

520. Copaibae 

Cubebae Oleores aa 5 i 

01. Santali .3 ii 

Div. in caps. No. xii. 

S. : One 3 times a day. 



212 PRESCRIPTION INCOMPATIBILITIES 

The following prescriptions, including the comments, were sent 
to me at my request by Mr. J. L. Lascoff, a well-known pharmacist 
of this city, whom I take this opportunity to thank for his courtesy. 
They are all prescriptions that were dispensed at his pharmacy. 

521. Tr. Ferri Chloridi 10.0 

Antipyrini 0.12 

Spiritus Aetheris Nitrosi 15.0 

Aquae ..ad 100.0 

M. D. S. A teaspoonful every hour. 

The antipyrin is added to produce a color reaction with 
the iron and as such is harmless ; but with the addition of the 
sweet spirit of niter, a sharp chemical reaction takes place. 
At first there is a purple mixture formed with the iron and 
the antipyrin, then when the niter is added it turns light 
green, and then when allowed to stand becomes olive green, 
and later brown. Chemically an iso-nitroso-antipyrin is 
formed which is considered by many a poisonous compound. 
This prescription as written is incompatible. The only rem- 
edy is to use the simple spirit of ether, which was done in 
this case by consent of the prescriber. [As the antipyrin is 
added merely as a coloring agent, while the spirit of nitrous 
ether possesses decided therapeutic properties, it is better to 
leave out the former, i. e., the antipyrin, and leave in the 
latter — the spirit of nitrous ether. — W. J. R.] 

522. Potassii Citratis . . 10.0 

Liquoris Ammonii Acetatis 

Spiritus Aetheris Nitrosi, aa 30.0 

Tincturae Cardamomi Compositae 15.0 

Aquae, q. s. ad 240.0 

A teaspoonful every three to four hours in water. 

When the above is compounded four changes of color take 
place as the result of chemical change. At first it is light 
brown, then red, then straw color, and finally becomes pur- 
ple. This is all due to the presence of the niter, which con- 
tains nitrous acid. 



PRESCRIPTION INCOMPATIBILITIES 213 

523. Potassii iodidi 8,0 

Spir. Aetheris Nitrosi 30.0 

Liq. Ammon. Acetatis 60.0 

Potassii Citratis 4.0 

Aquae, q. s. ad 180.0 

M. S. A teaspoonful every four hours in water. 

This prescription is somewhat similar to the preceding one, 
but contains an additional ingredient, KI. If dispensed in 
the order as written, it is entirely incompatible, but a clear 
mixture will result if put up as follows : Dissolve the potas- 
sium citrate in sufficient water, and add the solution of am- 
monium acetate, followed by the nitrous ether ; then dissolve 
the KI in the remainder of the water and mix both solutions. 

524. Tincturae Benzoini Compositae 30.0 

Codeinae Sulphatis 0.5 

Syrupi Tolutani, ad 180.0 

M. D. S. : Two teaspoonfuls every four hours. 
By mixing the ingredients as written, the benzoin settles 
down along the sides and neck of the bottle. We added 8.0 
gum acacia, emulsifying the benzoin; no precipitation occurs 
then. 

525. Tinct. Iodi gtt. xx 

Mentholis gr. viii 

Alboleni 1 oz. 

M. D. S.: Use as a spray. 

If compounded as Written, a turbid mixture results, on 
account of the alcohol and water in the tincture of iodine, 
and the oil. But by using iodine crystals with a few grains 
of KI equivalent to tincture, we eliminate the alcohol and 
water, and a clear uniform mixture results. 

526. Tr. Iodi 

Aq. Ammon. Fort aa 15.0 

Lin. Saponis Camphor, q. s. ad 60.0 

Liniment; use externally. 

On mixing the above mentioned ingredients a liniment re- 



214 PRESCRIPTION INCOMPATIBILITIES 

suits which is first of a dark shade ; it gradually gets lighter, 
then yellow, and finally becomes colorless. [This is of course 
due to the iodine combining with the ammonia, forming the 
colorless ammonium iodide. — W. J. R.] 

527. Orthof ormi 8.0 

Olei Olivae 120.0 

M. ft. sol. 

In order to make a uniform and clear mixture, it is neces- 
sary to heat the two ingredients, as the orthoform is insoluble 
in the cold oil. 

528. Sodii Iodidi 20.0 

Elixiris Ferri, Quin., et Stryehn. Phosph 180.0 

M. D. S. : A teaspoonful three times a day after meals. 

In this prescription the phosphate salts are incompatible 
with the sodium iodide, therefore we use the N.F.I.Q.S. which 
makes a clear and uniform solution. We find the same incom- 
patibility when using bromide salts. 

529. Tinet. Nucis Vomicae 8.0 

Tinet. Cardamomi Comp. 

Elix. Ferri Quininae et Strychninae Phosphatum 60.0 

Elixiri Digestivi (N. F.) 60.0 

S. : A teaspoonful after each meal. 

In this case, one should also use the N.F. preparation of 
the I.Q.S., which contains the tincture of ferric citro-chloride, 
otherwise the mixture is turbid and not uniform. (N. B.— 
Elixir I.Q.S. phosphates is not official now.) 

530. Brometone 0.12 

Pyramidon 0.3 

D. T. D. Capsulae No. 12. 

Sig. : One every 3 hours until relieved. 
When these two ingredients are mixed a soft mass results. 
To avoid this I added a small amount of Magnesium Oxide 
and triturated it very gently, filled in capsules and dispensed 
in a glass-stoppered bottle. 



PRESCRIPTION INCOMPATIBILITIES 215 

531. Sparteinae Sulphatis 0.05 

Sacchari Lactis q. s. 

M. f. tabellae {freshly prepared) No. 12. 
Sig. : One every 4 hours. 

In making ordinary tablets we always use diluted alcohol; 
in this case we used ether and absolute alcohol, otherwise 
the tablets would be too soft and stick together; it would 
also be impossible to remove them from the mold. 

532. Heroini Hydrochl , gr. 1/20 

Quininae Hydrochl gr. y<% 

Creosoti Carbonatis (Duotal) min. 10 

Tal. dos. soft capsules No. xxx. 
Sig.: One every 4 hours. 

We made a pill mass of the first two ingredients. We 
placed the pill in each capsule, then dropped 10 min. of the 
duotal in each soft capsule, sealed them properly and washed 
them off with pure alcohol. 

533. Quininae Hydrobrom 6.0 

Camphorae Monobromatae 4.0 

Ergotini 4.0 

Creosoti Carbonatis 6.0 

Divide into capsules No. xxx. 
Sig. : One three times a day. 

To the creosote carbonate I added acacia and a few drops 
of water, emulsified it, added the first three ingredients which 
were previously mixed in a separate mortar, and made a 
mass with the addition of 30 grains of magnesium oxide and 
sugar of milk. It was impossible to dispense this in soft 
capsules, and it was also difficult to make a mass. Without 
the addition of MgO the Creosote Carbonate would separate. 

531. Mentholis 5.00 

Phenolis s 3.00 

Zinci Oxidi 20.0 

MgC0 3 6.00 

Glycerini ,,,.,,,«.»,,.., , 5.00 



216 PRESCRIPTION INCOMPATIBILITIES 

Olei Amygdal. Dulcis 30.00 

Aquae Calcis 80.00 

Aquae Rosae, q. s. ad 240.00 

Sig.: Dab on skin every 2 hours. 

This lotion is frequently prescribed by a prominent skin 
specialist who complained that a solid mass forms on the 
bottom of the bottle, the lime and rose water being separated, 
and not fit for use. He asked me to experiment with it, and 
I solved the problem by dispensing it as follows: I mixed 
the zinc oxide with double the amount (12.00) MgC0 3 in a 
mortar, to this I added the almond oil and lime water pre- 
viously mixed, triturated this well, added the glycerin and rose 
water and put this mixture in the 8-oz. bottle. Then mixed 
the menthol with the phenol in a mortar and added it to the 
mixture. It formed an elegant lotion, which was perfectly 
white and uniform. The reason for the addition of MgC0 3 
is to make it more alkaline. The physician accepted my sug- 
gestion. 

535. Camphor 2.0 grammes 

Mix and make 30 pills. 

We triturate the camphor with about 1 gram of powdered 
soap and add a few drops of castor oil. This makes a mass 
which does not harden. It should be dispensed in a glass 
container well corked. [In the author's opinion it would 
be simpler and altogether preferable to powder the camphor 
and fill it dry in 30 capsules. It is good to inform the doctor 
that it is much better to dispense camphor in capsule than 
in pill form.— W. J. R.] 

536. Camphor 20 grains 

Menthol 10 grains 

Mix and make 25 pills. 

Triturate the camphor and menthol. To the resulting liq- 
uid add a mixture of extract of glycyrrhiza and powdered 
glycyrrhiza, and then a few drops of water. This makes a 



PRESCRIPTION INCOMPATIBILITIES 217 

very good mass. The finished pills should be coated to pre- 
vent evaporation of the camphor. 

537. Ammonium Chloride 4.0 grammes 

Powdered Camphor 0.6 grammes 

Syrup of Wild Cherry 30.0 grammes 

Distilled water, enough to make .... 120.0 grammes 

Triturate the camphor with 1 gram of granulated acacia 
to a fine powder and then add the syrup and water little by 
little. 

The following prescription was sent to me for experiment 
by the Druggists Circular. (See Jan., 1919, page 21.) 

538. Aeetanilid 3 oz. 

Phenacetin 2 oz. 

Salol 1 oz. 

Caffeine 1 oz. 

Ac. Tart gr. ccxxx 

Sod. Carbonat 3 oz. 

Spt. Vin. Rect. Dil cong. 1 

I experimented with 4 oz. I dissolved the aeetanilid in 3 
drams of alcohol, the phenacetin in 1 oz. of alcohol, and the 
salol and caffeine in 5 drams of alcohol (2 oz. of alcohol in 
all), and then mixed the three solutions. The tartaric acid 
and sodium carbonate were dissolved together in 2 ounces of 
water. Then the aqueous solution was gradually added to 
the spirituous one, when no untoward result ensued. 

539. Resorcini 2.3 

Sodii Boratis 5.0 

Cocaini Hydroehloridi 1.0 

Aquae Foenieuli 200.0 

Tincturae Opii Crocatae gtt. xx 

Sig. : Eye lotion. 

This makes a turbid mixture. If filtered, all the active in- 
gredients will be removed. By substituting boric acid for 
borax a clear solution is obtained. In a similar case a leading 
oculist, who prescribed holocaine with borax, was glad 



218 PRESCRIPTION INCOMPATIBILITIES 

to accept my suggestion that boric acid be substituted for the 
borax. [Borax being alkaline is incompatible with alkaloids. 
See prescription 28. — W. J. R.] 

540. Creosoti c. c. 0.12 

Balsam of Tolu gm. 0.2 

M. ft. pill, Mitte No. 50. 

It is easy enough to put this prescription in capsules, but 
to make pills of it, the following method should be adopted : 
Emulsify the creosote with a little acacia, adding finely pow- 
dered balsam of tolu, with enough powdered glycyrrhiza to 
make a suitable mass. [A very ingenious method, indeed. 
And if the doctor insists on prescribing creosote in pill 
form, the pharmacist has no choice ; but I feel in duty bound 
to utter my protest once more against the irrational practice 
of prescribing and dispensing liquids in pill form. — W. J. B.] 

541. Ox Gall gm. 16.0 

Oil of Turpentine c. c. 30.0 

Glycerin c. c. 120.0 

Ft. sol. Sig.: Dissolve one-fourth part in a quart of 
water and use as an enema. 

Compounded in the order in which the ingredients are 
named it will be impossible to produce a clear and uniform 
mixture; but by triturating the ox gall with a little of the 
glycerin and emulsifying the oil of turpentine with this, add- 
ing lastly the remainder of the glycerin, a satisfactory mix- 
ture will be effected. 

542. Resorcini 0.8 

Mentholis 0.8 

Benzoinolis Liq 90.0 

Sig.: Use as a spray. 

As resorcin is not soluble in the oil, we dissolved it in 10 
or 15 drops of ether, the menthol being dissolved in the oil 
previously warmed. A nice clear solution was obtained, 



ALPHABETICAL SUMMARY 

OF 

PRESCRIPTION INCOMPATIBILITIES 

Acacia. A solution of this gum forms a thick unsightly 
precipitate with a solution of lead subacetate (but not with 
lead acetate), a concentrated solution of borax, ferric salts 
and alcohol or alcoholic tinctures. The precipitation with 
borax does not occur if the mixture contains a fairly large 
amount of syrup or glycerin; there is no precipitate with 
ferric salts if the mixture contains a considerable amount 
of free acid or if the ferric salt is well diluted with water, 
syrup or glycerin. With alcohol the precipitate takes place 
only when the percentage of the alcohol is 60 or over. It 
is colored blue by tincture of guaiac. Acacia often acts as 
a preventative of precipitation. Notably it prevents the 
precipitation of alkaloids by tannic acid or even potassium- 
mercuric iodide (Mayer's reagent). 

Acetanilid. With spirit of nitrous ether it gives a yellow 
solution turning to red. It liquefies on being triturated with 
phenol, resorcin and thymol; with chloral hydrate it gives 
a damp powder. 

Acetates. Soluble acetates give a deep red color with ferric 
salts, due to the formation of ferric acetate (as in Basham's 
mixture). With quinine salts they give a bulky pasty pre- 
cipitate of quinine acetate. [Try, for instance, quinine bi- 
sulphate with sodium acetate.] Morphine acetate loses some 
acetic acid on exposure and becomes less soluble. Lead 
acetate on exposure loses some acetic acid, attracts carbon 
dioxide and becomes partially converted into lead carbonate. 

219 



220 PRESCRIPTION INCOMPATIBILITIES 

Acetozone. Decomposed on being heated with water, or in 
contact with alkalies. 

Acida. Acids. Practically all acids decompose carbonates 
and bicarbonates with effervescence and the liberation of car- 
bon dioxide, and the formation of salts of the corresponding 
acid. Hydrocyanic Acid is an exception. Remember that 
Carbolic Acid is chemically not an acid and does not act like 
one. 

Acidum Glycerophosphoricum is not used per se and will 
therefore be referred to under the head of its salts, the 
glycerophosphates. 

Acidum Aceticum. 1. In common with other acids, it de- 
composes carbonates, forming an acetate and liberating C0 2 . 
2. With a mixture of alcohol and sulphuric acid, as in aro- 
matic sulphuric acid, it forms acetic ether or ethyl acetate. 

Acidum Arsenosum. See Arseni Trioxidum. 

Acidum Benzoicum. This acid is but slightly soluble in 
water, but very soluble in alcohol: it is thrown out from its 
alcoholic solution by the addition of water. Its solubility in 
water is increased considerably by the presence of borax. 
See Benzoates. 

Acidum Carbolicum. See Phenol. 

Acidum Chromicum. See Chromii Trioxidum. 

Acidum Gallicum. Gives bluish-black color with ferric salts, 
and also with ferrous (because practically we seldom meet 
with chemically pure ferrous salts entirely free from ferric 
compounds). With ammonia compounds (aromatic spirit 
of ammonia) it gives a variably colored mixture and precipi- 
tate. With lime water a bluish-white (or rather dirty) pre- 
cipitate. With excess of sodium bicarbonate is said to give 
indigo blue color with blue-green precipitate. Vigorous tritu- 
ration with potassium permanganate may cause an explosion 
with the burning up of the acid. ( 

Acidum Picricum. Trinitrophenol. 1. Liable to explode 
unless carefully handled. 2. Must not be rubbed or heated 



ALPHABETICAL SUMMARY 221 

with readily oxidizable substances, as an explosion may occur. 
3. Forms a precipitate with most alkaloids. 

Acidum Tannicum. 1. Its most important incompatibility 
is with the alkaloids, as it precipitates practically all of 
them in the form of tannates. If the mixture is strongly 
alcoholic no precipitation may take place, as the tannates of 
the alkaloids are soluble in alcoholic media. Antipyrin being 
of the nature of an alkaloid, tannic acid precipitates it. 2. It 
precipitates some glucosides (digitalin) and some neutral 
principles. 3. It precipitates many of the metals, in the form 
of a tannate, the most important being lead, copper, mer- 
cury and silver. 4. "With ammonia and potassium hydroxide 
and carbonate it gives a slight precipitate. 5. "With lime 
water it gives a bluish-white precipitate, turning darker. 
6. With ferric salts it gives a bluish-black or green-black solu- 
tion. 7. With ferrous salts it is supposed to give a white 
precipitate, but as we practically never see ferrous salts 
entirely free from ferric compounds, the result is that with 
ferrous salts the precipitate is also dark. 

8. It decolorizes a solution of iodine (unless the latter 
is in excess), combining with it to form various compounds. 
That there is a true chemical reaction between iodine and tan- 
nic acid is seen from the fact that the former does not color 
starch blue in the presence of the latter. 9. It is incompatible 
with potassium permanganate, reducing the latter. 10. W 7 ith 
spirit of nitrous ether, there is evolution of gas, probably 
various oxides of nitrogen. It is supposed to be incompatible 
with iodoform, but the writer doubts it. 

All tannin-containing drugs will of course have the same 
incompatibilities as tannic acid. Drugs containing a large 
amount of tannin are: krameria, kino, gambir, hematoxylin, 
quercus, rubus and wild cherry. 

Aconitina. Aconitine should best be administered by itself 
if in solution, or in the form of pills or granules. It is not 
likely to be prescribed in concentrated solution, and in dilute 



222 PRESCRIPTION INCOMPATIBILITIES 

solution it is precipitated only by tannic acid and mercuric- 
potassium iodide (also gold chloride). 

Aethylis Carbamas. Urethane. Produces a liquid or moist 
mass when triturated with antipyrin, benzoic acid, betanaph- 
thol, camphor, hydrated chloral, exalgin, menthol, resorcin, 
trional, salol, salicylic acid, thymol. 

Agurin. See Theobrominae Sodio-Acetas. 

Alkaloids. Great care is necessary in prescribing these, be- 
cause most of them being potent drugs, precipitation may 
cause serious consequences, by an overdose of the alkaloid 
being poured out in one dose. Whenever feasible, alkaloids 
should be prescribed by themselves, either in solution or in 
the form of granules, pills, etc. Alkaloids should not be pre- 
scribed with: Potassium hydroxide, carbonate and bicar- 
bonate ; sodium hydroxide, carbonate, bicarbonate and borate 
(also phosphate) ; ammonia water and ammonium carbonate; 
lime-water, iodides, bromides, tannic acid (or substances con- 
taining tannin); mercuric chloride; gold chloride. Besides 
the foregoing, quinine is also incompatible with salicylates and 
acetates. The reason the alkaloids are incompatible with the 
above enumerated substances is because the alkaloids are 
precipitated by them. For instance, if we prescribe morphine 
sulphate and ammonia water or ammonium carbonate (or the 
aromatic spirit of ammonia, which contains those substances), 
pure alkaloidal morphine, which is but very slightly soluble, 
will precipitate; if we prescribe morphine sulphate and tan- 
nic acid, morphine tannate will precipitate; if we prescribe 
strychnine sulphate and mercuric chloride, a double salt of 
strychnine and mercury will precipitate, etc. 

It is well to bear in mind that, as a general rule, which, 
however, has a number of exceptions, the pure alkaloids are 
insoluble or very slightly soluble in water, but soluble in al- 
cohol, in fixed oils and in oleic acid. It is just vice versa with 
alkaloidal salts. 

(N. B. — The alkaloids, or their salts, official in the phar- 
macopeia, are: Aconitine, aethylmorphine, apomorphine, 



ALPHABETICAL SUMMARY 223 

atropine, betaencaine, caffeine, cinchonidine, cinehonine, co- 
caine, codeine, colchicine, cotarnine, diacetylmorphine, 
emetine, homatropine, hydrastine, hydrastinine, hyoscyamine, 
morphine, pelletierine, physostigmine, pilocarpine, quinine, 
scopolamine, sparteine, strychnine, theobromine, theophylline ; 
in practice, codeine may be prescribed with alkalies, because 
the pure alkaloid is itself quite soluble in water.) 

Aloinum. Precipitated by tannic acid; but as aloin is al- 
most invariably prescribed in pill or capsule form, it is hardly 
necessary to consider its alleged incompatibilities. 

Alumen. Alumini et Potassii or Alumini et Ammonii Sul- 
phas. 1. Alum is incompatible with the alkaline hydrates and 
their carbonates and lime water, aluminum hydroxide being 
precipitated. 2. With borax, aluminum borate (and some 
hydroxide) being precipitated. It has all the incompatibili- 
ties of the soluble sulphates. 

Alypin. 1. This local anesthetic being in the nature of an 
alkaloid is precipitated by alkaline hydroxides and carbonates 
and by most of the alkaloidal reagents or precipitants. 2. As 
the alypin ordinarily used is alypin hydrochloride, it gives 
naturally a precipitate with silver nitrate. When it is de- 
sired to prescribe alypin with silver nitrate, alypin nitrate, 
which is also obtainable, should be ordered. 

Amyli Nitris. Amyl Nitrite. As amyl nitrite is now dis- 
pensed exclusively by itself, in the form of glass pearls, it is 
useless to discuss its incompatibilities. 

Antipyrina. 1. With ferric chloride either in the form of 
solution or tincture and other ferric salts antipyrine gives 
a deep-red color. (Not with the solution of ferric citro- 
chloride, unless a mineral acid is added). 2. With calomel, 
particularly in the presence of moisture and of sodium bicar- 
bonate, a small part of the calomel is converted into mercuric 
chloride. 3. With spirit of nitrous ether a beautiful green 
color is formed ; if the spirit is neutral in reaction, the forma- 
tion of the color is delayed and the addition of a crystal of 
potassium bicarbonate may delay reaction for several days. 



224 PRESCRIPTION INCOMPATIBILITIES 

This green compound which is iso-nitroso-antipyrine, is, con- 
trary to prevalent belief, hardly if at all poisonous. 4. Rubbed 
with hydrated chloral, phenol, piperazine or sodium salicy- 
late, a soft mass or liquid is formed. 

Argenti Nitras. Silver nitrate is a delicate chemical and 
is easily decomposed by light and in contact with organic 
matter. It should always be kept in amber colored or blue 
bottles. It is best prescribed alone dissolved in distilled 
and freshly boiled water. Its principal incompatibilities are 
soluble chlorides, which at once precipitate silver chloride, 
borax (silver borate precipitating) and tannic acid (precipi- 
tate of silver tannate). 

Argonin. Silver Casein. It is incompatible, a precipitate 
being formed, with : silver nitrate, zinc sulphate, carbolic acid, 
tannic acid and lead acetate. 

Aristol. See Thymolis Iodidum. 

Argyrol. Incompatible with zinc sulphate, lead acetate 
and tannic acid, a precipitate being formed. 

As argyrol stains the skin and linen badly, it is well to 
know that the stains are quickly and completely removed by 
a solution of mercuric chloride. 

Arseni Iodidum. Arsenic iodide should not be prescribed 
in solution with alkaloidal salts, as many of them are precipi- 
tated. 

Arseni Trioxidum. 1. Incompatible with dialyzed iron and 
some other ferric salts, due to the formation of the insoluble 
basic ferric arsenite. 2. Incompatible with hypophosphites 
in acid solution and hypophosphorous acid, because reduced 
to metallic arsenic. 3. Said to be incompatible with strych- 
nine salts, precipitating strychnine arsenite. 

Asaprol. Calcium Beta-Naphthol Sulphonate. 1. Is decom- 
posed by mineral acids, beta-naphthol being precipitated. 
2. With solution of antipyrine a precipitate is formed. 

Auri et Sodii Chloridum. Gold and sodium chloride should 
best be prescribed alone, and preferably in pill form. 1. It 
is apt to precipitate alkaloids, but such precipitation may 



ALPHABETICAL SUMMARY 225 

be prevented by the addition of a small amount of sodium 
thiosulphate. 2.' It is incompatible with potassium iodide. 
3. It is incompatible, being reduced to the metallic state, 
with potassium arsenite, mercurous and ferrous salts, many 
organic substances; also reduced by light and heat, and by 
metallic iron. 

Benzoates. Soluble benzoates give a salmon-colored pre- 
cipitate with ferric salts, due to the formation of ferric ben- 
zoate. They are incompatible, in aqueous solution, with acids, 
because the latter decompose them, liberating benzoic acid, 
the crystals of which float about in the mixture (benzoic 
acid being but slightly soluble in water). 

Bicarbonates. 1. All bicarbonates cause an effervescence 
with acids, with the liberation of carbon dioxid. 2. They 
precipitate many alkaloids, particularly in concentrated so- 
lution. 3. When a solution of bicarbonate is heated it is con- 
verted into carbonate. This is an important point to remem- 
ber, because the carbonates of potassium and sodium are much 
stronger and more irritant than the corresponding bicar- 
bonates. 

Bichromates (potassium) and Chromates form precipe 
tates with salts of lead, silver, mercury and strontium. Po- 
tassium bichromate forms precipitates with many alkaloids. 
Great care should be taken in triturating bichromates with 
sugar, tannic acid, sulphur and other easily oxidizable sub- 
stances. 

Bismuthi et Ammonii Citras. Incompatible with acids, 
the latter decomposing the double salt, and bismuth citrate, 
or another basic salt of bismuth, being precipitated. 

Bismuthi Subnitras. 1. With carbonates and bicarbonates 
in solution, carbon dioxide is liberated, due to the liberation 
of some nitric acid from the subnitrate. 2. Potassium iodide 
and other iodides convert it into the yellow to red bismuth 
iodide. 3. With sodium salicylate it is said to form bismuth 
salicylate. We have not found this to be the case. A mixture 
of bismuth subnitrate and sodium salicylate in water remains 



226 PRESCRIPTION INCOMPATIBILITIES 

unchanged for a long time. 4. "With an aqueous solution of 
tannic acid it gradually forms the yellow tannate of bismuth. 
5. The same is true of gallic acid. 

Caffeina. It is well to know that the solubility of caffeine 
and its salts is increased by the presence of sodium salicylate, 
sodium benzoate and antipyrine. It is for this reason that for 
hypodermic and intravenous injections we generally use 
"double" salts of caffeine, such as caffeine-sodium salicylate. 

Calcium-Betanaphthol Sulphonate. See Asaprol. 

Calx Sulphurata. Sulphurated lime is incompatible with 
mineral acids, which decompose it, forming hydrogen sul- 
phide, etc. 

Camphora. 1. Camphor forms a liquid or soft mass when 
triturated with chloral, phenol, guaiacol carbonate, betol, an- 
tipyrine or thymol. 2. Water added to an alcoholic solution 
of camphor (spirit of camphor) throws the camphor out of 
solution. 3. A strong solution of a salt, such as potassium 
bromide, in camphor water, will throw the camphor out of 
solution. 

Camphora Monobromata. Monobromated camphor forms a 
liquid or soft mass when triturated with chloral, phenol, salol 
or thymol. 

Carbo. Charcoal is best not prescribed in mixtures con- 
taining alkaloids, glucosides or tannic acid, as it is apt to 
precipitate them. 

Carbonates. 1. The alkaline carbonates act practically as 
the corresponding hydroxides in precipitating alkaloids, etc. 
2. They give an effervescence with all acids (with the ex- 
ception of hydrocyanic acid) with the liberation of carbon 
dioxide. 3. They form precipitates with soluble salts of mag- 
nesium, calcium, barium, strontium, iron, manganese, silver, 
aluminum, antimony, copper and zinc. 

Chloralamide. See Chloralformamidum. 

Chloralformamidum. Chloralamide. Forms a soft mass if 
rubbed with antipyrine, menthol or camphor. 

Chloralum Hydratum. Hydrated Chloral. Chloral Hy- 



ALPHABETICAL SUMMARY 227 

drate. 1. When rubbed with camphor forms a thick, clear 
liquid : camphor-chloral. 2. Forms a liquid or soft mass when 
triturated with any of the following: phenol, guaiacol car- 
bonate, quinine sulphate, trional, agurin, hedonal. 

Chloretone. 1. Forms a liquid or soft mass if triturated 
with phenol, menthol, antipyrine (also exalgin or euphorin). 
2. Said to be decomposed by alkalies and acids. 

Ohinosol. Oxyquinolin Sulphate. 1. An aqueous solution 
gives a precipitate with alkaline hydroxides and soap solu- 
tion. 2. Incompatible with mercuric chloride. 

Chlorates. 1. Chlorates are strong oxidizers and should 
not be triturated or heated with any oxidizable substance, 
such as the following: charcoal, sugar, sulphur, sulphides 
and sulphites, thiosulphates, hypophosphites, nitrites ( ! ) , re- 
duced iron, iodine, tannic acid, gallic acid, salicylic acid, 
phenol, starch, lycopodium. Nor should they be triturated in 
the dry state with glycerin and honey; in the presence of 
water, however, the mixture is quite safe. 2. When hydro- 
chloric acid is added to a chlorate, free chlorine is given off 
and a number of oxides of chlorine are formed. 

Chromii Trioxidum. Chromic Acid. Absolutely incompati- 
ble with alcohol, ether, glycerin and other organic solvents, 
decomposition taking place sometimes with dangerous vio- 
lence (explosion). Incompatible with hydrogen dioxide. 

Citrophen. See Paraphenetidin Citrate. 

Cocaina. Aside from the usual alkaloidal incompatibilities, 
it is well to know that an ointment of yellow mercuric oxide 
and cocaine hydrochloride, such as is not infrequently pre- 
scribed for inflamed eyelids, is apt to be more irritating 
than the ointment of the mercuric oxide alone, without the 
cocaine. This is due to the fact that the cocaine hydro- 
chloride probably forms some mercuric chloride. 

Codeina. 1. Codeine is precipitated by most of the alka- 
loidal precipitants, but not by the alkaline carbonates and 
bicarbonates. 2. It is usually stated that codeine is incompati- 
ble with some ammonium salts, such as ammonium chloride, 



228 PRESCRIPTION INCOMPATIBILITIES 

because ammonia is liberated. This is a purely theoretical 
incompatibility. Ammonium chloride and codeine have been 
prescribed for years, in tens of thousands of prescriptions, 
and may continue to be prescribed without any fear or appre- 
hension. 

Collodium. 1. Of course collodium must not be mixed 
with water, as the gun-cotton will at once precipitate from 
its alcohol-ether menstruum. 2. Ammonia water also gives 
a precipitate. 3. A gelatinous mass is formed with phenol 
and with an excess of creosote. 4. The tincture of iodine of 
the present pharmacopeias, i. e., one that contains potassium 
iodide, may be mixed with collodion without precipitation. 

Creosoti Carbonas. Creosotal. Creosote carbonate is sel- 
dom prescribed with ingredients with which it is incompatible. 

Creosotum. 1. Creosote gives a bluish or violet-blue color 
with ferric salts ; the color changes to greenish and then dirty 
brown; usually, unless the solutions are very dilute, there is 
also a brown precipitate. 2. Forms a white precipitate with 
solution of lead subacetate. 3. If present in considerable ex- 
cess forms a gelatinous mass with collodion. 

Diacetylmorphinae Hydrochloridum. Heroin Hydrochlo- 
ride. Heroin being an alkaloid has the usual alkaloidal in- 
compatibilities. It is stated that both alkalies and acids read- 
ily convert it into morphine. 

Diuretin. See Theobromine Sodio-Salicylas. 

Epinephrin. Adrenalin, Suprarenalin, Suprarenin, Supra- 
capsulin, Adnephrin. Epinephrin is one of those substances 
that are best prescribed alone. It gets readily decomposed 
and worthless in the presence of oxidizing agents. It should 
not be prescribed with silver nitrate, mercuric chloride, hy- 
drogen dioxide, etc. Whenever a solution of adrenalin has 
acquired a brown, red, or even pink color, it has become 
deteriorated and should be discarded. 

Exalgin. Methyl Acetanilid. Forms a soft mass when 
rubbed with phenol, menthol, hydrated chloral, resorcin, 
salicylic acid 



ALPHABETICAL SUMMARY 229 

Ferric Salts. 1. Alkaline hydroxides and carbonates cause 
a red-brown precipitate of ferric hydroxide. 2. Sodium bo- 
rate gives a precipitate of -ferric borate. 3. Alkali phosphates 
give a precipitate of ferric phosphate, largely or entirely pre- 
vented by the presence of sodium or potassium citrate or 
tartrate. 4. Potassium or sodium hypophosphite gives a pre- 
cipitate of ferric hypophosphite. 5. Tannic acid gives a black 
color and precipitate, and this is true of all vegetable drugs 
which contain tannic acid. 6. Gallic acid gives a bluish black 
color. 7. Soluble acetates (potassium, sodium, ammonium) 
form a deep red color, but no precipitate, with ferric salts, 
due to the formation of ferric acetate. Acetic acid does not 
produce a red color with ferric salts. 8. Soluble benzoates 
give a flesh colored precipitate. 9. Salicylates give a deep 
violet color, and in concentration a violet precipitate of ferric 
salicylate. 10. Arsenites and arsenates give a precipitate 
of ferric arsenite and arsenate. 11. A solution of phenol, 
creosote or guaiacol gives a violet blue color. 12. Anti- 
pyrine gives a deep red color. So does phenacetin. Acet- 
anilid gives a red color only in alcoholic solution. 13. Resor- 
cin gives a dirty violet color. 14. Salol being a salicylate 
gives a violet color if dissolved in alcohol. So does oil of 
wintergreen and oil of sweet birch, both being chemically 
methyl salicylate. 15. A number of volatile oils, such as oils 
of cinnamon, cloves, pimenta, thyme, give a blue, green or 
brown color. 16. With mucilage of acacia ferric salts form 
a gelatinous mass. 17. Ferric salts, particularly ferric chlor- 
ide, liberates iodine from iodides, and bromine from bromides. 
18. It is well to bear in mind that syrup and glycerin prevent 
or retard some of the reactions enumerated above. 

Ferri Phosphas (Solubilis). 1. The soluble ferric phosphate 
is incompatible with mineral acids which precipitate ferric 
phosphate (the insoluble form) ; the only exception is glacial 
phosphoric or metaphosphoric acid free from orthophosphoric 
acid; this does not cause a precipitate. 2. Potassium and 



230 PRESCRIPTION INCOMPATIBILITIES 

sodium hydroxide (but not ammonium hydroxide) cause a 
precipitate of ferric hydroxide. 

Ferri Pyrophosphas (Solubilis). Everything said about 
ferric phosphate applies to ferric pyrophosphate. 

Ferrous Salts. There are but two ferrous salts official, the 
saccharated carbonate and the sulphate; the first is always 
prescribed in the dry state (in the form of powders, pills or 
capsules) and the second almost always; so the probability of 
coming across any incompatibles of ferrous salts is very re- 
mote. 

Ferrum. Metallic Iron. Reduced Iron. Reduced Iron 
must not be triturated with potassium permanganate or potas- 
sium chlorate; while the danger of an explosion is rather re- 
mote, still under certain circumstances it may occur. 

Fluidextracta. Most fluid extracts being made with alcohol 
and containing resinous or other extractive matters give a 
precipitate when mixed with water. 

Glucosides. Many glucosides are precipitated by tannic 
acid, and are as a rule decomposed by acids and alkalies. 

Glycerinum. 1. Glycerin is absolutely incompatible with 
potassium permanganate and chromic acid. 2. With sodium 
borate a complex reaction occurs, glycerol borate and sodium 
metaborate being formed (or, as it is claimed by some, sodium 
glyceryl borate and glyceroboric acid), but for all that the 
two are not incompatible and may be safely prescribed to- 
gether. 

Glyceritum Boroglycerini. The boric acid is in chemical 
combination with the glycerin, probably in the form of glyceryl 
borate; on mixing it with water it is decomposed, and the 
liberated boric acid may precipitate out, if there is not suf- 
ficient water to hold it in solution. 

Glycerophosphates. The only real incompatibility of the 
glycerophosphates are the mineral acids, which decompose 
them with the liberation of glycerophosphoric acid. The so- 
dium glycerophosphate and the potassium glycerophosphate 
are very deliquescent and cannot be prescribed in powder or 



ALPHABETICAL SUMMARY 231 

capsule form. Calcium glycerophosphate is not deliquescent. 

Glycyrrhizinum Ammoniatum. This is decomposed by 
mineral acids, glycyrrhizic acid precipitating, and the sweet 
taste being changed to bitter. It should therefore never be 
prescribed with sulphuric acid, hydrochloric acid, etc. 

Guaiacolis Benzoas. Benzosol. Decomposed by alkaline 
hydroxides into guaiacol and a benzoate of the alkali. 

Guaiacolis Carbonas. Duotal. 1. Forms a soft mass when 
rubbed with chloral hydrate. 2. Like other guaiacol salts it 
is decomposed by alkali hydroxides, being split into guaiacol 
and a carbonate of the alkali. 

Guaiacolis Salicylas. Decomposed by alkaline hydroxides 
into guaiacol and a salicylate of the alkali. 

Guaiacolum. The incompatibilities are practically those of 
creosote. 

Heroin. See Diacetylmorphine. 

Hexamethylenamina. Urotropin, Formin, Aminoform, 
Cystogen. Though this drug is prescribed in enormous 
amounts, still we know of no drugs with which it is incompati- 
ble. It is claimed that it is decomposed by hot water, but we 
are not sure even of this statement. "We have been ordering 
it dissolved in hot water for a great many years, and the drug 
does not seem to be injured thereby. The only thing we want 
to caution the patient about is to take the hexa dissolved in or 
followed by a large amount of water, as otherwise it may prove 
irritating to the stomach. 

Holocainae Hydrochloridum. Being an alkaloid, it has the 
incompatibilities of all alkaloids. 

Homatropina. Being an alkaloid it has the incompatibil- 
ities of all alkaloids, and particularly of atropine. 

Hydrargyrum Ammoniatum is decomposed by potassium, 
sodium or calcium hydroxide, ammonia being set free and the 
yellow mercuroxyarmnonium chloride being formed. 

Hydrargyri Chloridum Corrosivum. Corrosive sublimate 
has many incompatibilities. 1. It might not incorrectly be 
stated that it is incompatible to a certain extent with water, 



232 PRESCRIPTION INCOMPATIBILITIES 

because an aqueous solution of it is gradually decomposed, 
being partly changed into calomel. Ammonium chloride pre- 
vents this change and for this reason, corrosive sublimate 
tablets are generally made to contain some ammonium chloride. 
Hydrochloric, citric or tartaric acid also prevents the change. 
2. The salt with which mercuric chloride is most frequently 
prescribed is potassium iodide. Strictly speaking the com- 
bination is incompatible, because red mercuric iodide is 
formed, but this salt quickly dissolves in the excess of potas- 
sium iodide, the double salt, potassio-mercuric iodide, being 
formed; and from a practical, therapeutic point of view the 
combination is unobjectionable. 3. It is incompatible with the 
hypophosphites as they reduce the corrosive sublimate to 
calomel, and eventually to metallic mercury. 4. Incompati- 
ble with arsenites, which reduce it to calomel and then to 
metallic mercury. 5. It is incompatible with, because it pre- 
cipitates, most alkaloidal salts. 6. It is incompatible with lime 
water and with potassium and sodium hydroxide which pre- 
cipitate it as mercuric oxide or mercuric oxychloride. 7. Am- 
monia water and ammonium carbonate precipitate it as 
ammoniated mercury or mercuric ammonium chloride. 8. 
Potassium carbonate or sodium carbonate gives a precipitate, 
consisting of a mixture of mercuric oxychloride and mercuric 
oxide. 9. Potassium bicarbonate or sodium bicarbonate also 
gives a precipitate, first white, then turning to red, of various 
oxychlorides of mercury, with a slight effervescence. 10. It is 
incompatible with borax which precipitates it as mercuric 
oxychloride, of a reddish brown color. 

Hydrargyri Chloridum Mite. 1. As calomel and iodoform 
are frequently prescribed together, it is well to know that a 
chemical combination takes place between the two, particularly 
in the presence of moisture, some red mercuric iodide being 
formed. This is also true of other compounds containing 
iodine, such as aristol, airol and europhen. 2. Calomel should 
not be prescribed with cocaine or cocaine hydrochloride in eye 
salves, as a small amount of mercuric chloride is formed which 



ALPHABETICAL SUMMARY 233 

may prove irritating to the eye. 3. The incompatibility of 
calomel with sodium bicarbonate is a myth, and the physician 
need have no hesitation in prescribing, nor the pharmacist in 
dispensing, this combination. 4. It is incompatible with the 
hydroxides of potassium sodium, potassium and calcium which 
convert it into the black mercurous oxide ("Black Wash"). 
5. Sodium and potassium carbonates convert it into mercurous 
oxide and carbonate. 6. Ammonia water and ammonium car- 
bonate convert it into black mercurous ammonium chloride. 
7. Soluble iodides (as well as soluble bromides) convert 
calomel, in the presence of moisture, into mercurous iodide (or 
bromide), which is apt to become further decomposed into 
mercuric iodide (or bromide) and metallic mercury. 8. Con- 
trary to the prevalent belief calomel is not incompatible with 
sodium chloride or hydrochloric acid. 9. It is not advisable 
to prescribe iodine and calomel in the same ointment, as 
mercuric iodide may form, which is very irritating. 

Hydrargyri Iodidum Flavum. Mercurous iodide is in- 
compatible with iodides, becoming decomposed into the more 
toxic mercuric iodide and metallic mercury. 

Hydrargyri Iodidum Rubrum. The red mercuric iodide 
which is only slightly soluble in water is very soluble in the 
presence of a soluble iodide with which it forms a double salt. 
It is therefore often prescribed in combination with potassium 
iodide. 

Hydrargyri Salicylas. This practically insoluble salt dis- 
solves in a solution of sodium chloride, also in a solution of 
the chlorides, iodides and bromides of the other alkalies. And 
a solution of it in physiologic salt solution is used for hypo- 
dermic injections. 

Hyoscyamina. The alkaloid hyoscyamine, contrary to other 
alkaloids, is not precipitated by potassium or sodium bicarbo- 
nate ; you need therefore have no hesitation in prescribing 
fluidextract of hyoscyamus in combination with potassium bi- 
carbonate, as is so often done in cystitis and in acute 
gonorrhea. 



234 PRESCRIPTION INCOMPATIBILITIES 

Ichthyol. 1. Ichthyol is chemically ammonium sulphich- 
thyolate, and is decomposed by acids, the sulphichthyolic or 
ichthyolsulphonic acid precipitating in the form of a sticky 
mass. 2. It gives a precipitate with potassium iodide, potas- 
sium bromide, zinc sulphate, and alum. These are really the 
only incompatibilities of any practical importance. The other 
so called incompatibilities are only such in theory and need not 
be taken into account. 

Iodoformum. 1. Iodoform mixed with calomel may under 
certain circumstances (exposure to light) enter into chemical 
action and form some mercuric iodide. 2. It is perhaps slowly 
decomposed and also deodorized by tannic acid. 3. It is not 
incompatible with Balsam of Peru, statements to the contrary 
notwithstanding. 

Iodum. Iodine is prescribed practically in two forms only : 
that of the tincture and that of the ointment. The tincture 
of the present pharmacopeia contains potassium iodide and is 
therefore readily miscible with water, which was not the case 
with the tincture of iodine of the old pharmacopeias. The 
tincture has few incompatibilities. 1. It is best to be careful 
about mixing it with ammonia water, as there is a possibility 
— a slight one — of ' ' iodide of nitrogen ' ' being formed, which 
when in the dry state is highly explosive. 2. "With metallic 
mercury iodine combines to form first mercurous and then 
mercuric iodide. This is a point of practical importance, 
because doctors often prescribe ung. iodi and ung. hydrargyri 
in the same prescription, and such an ointment sometimes 
proves highly irritating and burning, due to the formation 
of mercuric iodide. 3. Iodine when added to oil of turpentine 
occasionally causes a violent reaction. 4. Tincture of iodine 
or Lugol's solution precipitates most alkaloids. 

Lactophenin. Phenetidin Lactate. Incompatible with, be- 
cause decomposed by, acids and alkalies. 

Liquor Arseni et Hydrargyri Iodidi. Donovan's Solution. 
This double iodide solution precipitates nearly all alkaloids. 

Liquor Calcis. Lime water. Absorbs carbon dioxide from 



ALPHABETICAL SUMMARY 235 

the air, forming calcium carbonate which precipitates. Should 
therefore not be exposed to the air. Incompatible with numer- 
ous substances, discussed under their proper headings. 

Liquor Formaldehydi. 1. Formaldehyde is incompatible 
with hydrogen dioxide which oxidizes it to formic acid. Iodine 
is claimed to do the same thing. 2. It is incompatible with 
potassium permanganate, and we take advantage of this in- 
compatibility in disinfecting rooms by the formaldehyde- 
permanganate method. 3. With ammonia formaldehyde com- 
bines to form hexamethylenamine. It is for this reason that 
ammonia water is an efficient antidote in poisoning with 
formaldehyde. 

Liquor Hydrogenii Dioxidi. While hydrogen dioxide is a 
strong oxidizing agent, it is so seldom prescribed in combina- 
tion, that its importance as an incompatible factor is not very 
great. Many of the statements made regarding it are not true. 
So it is usually stated that hydrogen dioxide converts calomel 
into mercuric chloride; this is not so; the calomel undergoes 
no change. A few points are important to bear in mind. 1. It 
is absolutely incompatible with potassium permanganate. 2. 
It is incompatible with carbolic acid. 3. Incompatible with 
formaldehyde. 4. Its incompatibility with g^cerin is myth- 
ical. The two may very well be prescribed together. 

Liquor Plumbi Subacetatis. 1. With mucilage of acacia it 
forms a thick gelatinous mass, — if concentrated; if diluted, 
stringy pieces are formed. Lead acetate does not form a pre- 
cipitate with mucilage of acacia. 2. Forms a precipitate with 
a strong solution of phenol. 

Liquor Potassii Arsenitis. Besides the incompatibilities of 
arsenites, Fowler's solution is incompatible with alkaloids, 
because it contains some potassium bicarbonate (and car- 
bonate). 

Lithium Salts. The only incompatibilities of practical im- 
portance of the lithium salts are potassium, sodium and am- 
monium carbonate and phosphate. They give a precipitate of 
lithium carbonate and lithium phosphate. 



236 PRESCRIPTION INCOMPATIBILITIES 

Magnesium Salts. The soluble magnesium salts, particu- 
larly in concentrated solution, are precipitated by the alkaline 
hydroxides (as magnesium hydroxide) ; by the alkaline car- 
bonates (as basic magnesium carbonate) and by alkaline phos- 
phates (as magnesium phosphate). 

Mel. Honey is supposed to decompose borax with the liber- 
ation of boric acid, but this is no incompatibility, but an ad- 
vantage, and while the well-known, old time preparation of 
mel boracis — honey with borax — is becoming obsolete, there is 
no harm in it, and there should of course be no hesitation in 
dispensing it. 

Menthol. 1. When menthol is triturated with camphor, 
thymol, hydrated chloral or resorcin, the mixture becomes 
liquid. 2. When water is added to an alcoholic solution of 
menthol, the menthol separates out in the form of oily drops. 

Methylis Salicylas. Methyl salicylate, or oil of sweet birch 
or artificial oil of wintergreen, gives a deep violet color with 
ferric salts. 

Morphina. 1. Besides the general incompatibilities of al- 
kaloids, morphine gives a blue, changing to dirty green, color 
with ferric chloride in neutral aqueous solution. Acid or 
alcohol prevents this color reaction. 2. It gives a yellowish 
color with spirit of nitrous ether. 3. It is claimed to be 
oxidized by chlorates. 

Novocaine. Novocaine being an alkaloid, its salts are pre- 
cipitated, like other alkaloidal salts, by alkaline hydroxides, 
carbonates, etc. 

Olea Fixa. Fixed or Fatty Oils. 1. The usual error of the 
inexperienced druggist is that fixed oils are readily soluble in 
or miscible with glycerin. They are not. Nor are they soluble 
in alcohol, the only exceptions being castor oil and croton oil. 
2. With alkaline hydroxides fixed oils combine and form soaps 
or emulsion-like mixtures. This is taken advantage of in a 
number of pharmaceutical preparations. 

Olea Volatilia. Volatile or Essential Oils. Volatile oils are 
soluble in alcohol and only to a slight extent in water. When 



ALPHABETICAL SUMMARY 237 

water is added to an alcoholic solution of a volatile oil, the 
latter therefore separates out and a turbidity or milkiness is 
produced. — Oil of cloves gives a green color with tincture of 
ferric chloride. Oil of cinnamon gives a brown color. 

Opium. 1. On account of the morphine and the meconic 
acid which it contains, tincture of opium gives a red color 
with solution of ferric chloride. With tincture of iron the 
reaction is not pronounced. 2. Tincture of opium contains 
numerous alkaloids which are thrown out of solution by most 
of the alkaloidal precipitants. 3. The well known lead and 
opium wash — Lotio Plumbi et Opii — is an incompatible com- 
bination. Nevertheless it will continue to be prescribed, be- 
cause physicians claim good results from it in various inflam- 
matory conditions, in bruises and in sprains. 

Oxidizing Agents. In studying incompatibilities, we often 
come across the term "oxidizing agents." Oxidizing agents 
are chemicals that more or less readily give up their excess of 
oxygen to substances which readily combine with that oxygen, 
in other words, are readily oxidized. The most important 
oxidizing substances from a practical point of view are chlo- 
rates, permanganates, nitrates (chromates), also chromic, nitric 
and nitrohydrochloric acids. These chemicals should not be 
mixed, or only very carefully, with sulphur, charcoal, hypo- 
phosphites, tannic acid, glycerin, honey, starch, sugar and 
vegetable powders in general. 

Pancreatinum. Pancreatin in aqueous solution is precipi- 
tated by strong alcohol and mineral acids, and its value is 
diminished — so it is generally held — by contact with those 
substances, as well as in the presence of pepsin. 

Paraldehydum. It is claimed that paraldehyde is incom- 
patible with iodides, because it decomposes them with the liber- 
ation of iodine. 

Paraphenetidin Citrate. Citrophen. Gives a red color with 
ferric salts. 

Piperazina. 1. All that it is really necessary to remember 
about piperazine is that it is strongly alkaline and that it 



238 PRESCRIPTION INCOMPATIBILITIES 

should therefore not be prescribed with alkaloids, as it would 
cause their precipitation. 2. As piperazine is hygroscopic it 
should not be prescribed in powder form. 3. Particularly 
with acetanilid or antipyrine it is apt to form a liquid or soft 
mass. 

Pepsinum. Pepsin is considered incompatible with alkalies, 
alcohol, and hydrochloric acid of a higher concentration than 
0.5 per cent! All those substances on prolonged contact are 
supposed to destroy its digestive activity. 

Peroxida. Peroxides are incompatible with acids which de- 
compose them with the liberation of hydrogen peroxide. When 
dissolved in water, the same reaction takes place, only more 
slowly. 

Petrolatum. 1. Petrolatum, liquid or solid, is not miscible 
with glycerin, water or alcohol ; with the solid petrolatum small 
quantities of those liquids can be incorporated. 2. In incor- 
porating alkaloids with petrolatum it is best to use the free 
alkaloids instead of the alkaloidal salts, because the former are 
slightly soluble in petrolatum, but not the latter. 

Phenocoll Hydrochloride. Phenocoll is alkaloidal in its 
character and has the general incompatibilities of the alkaloids. 

Phenol. Carbolic Acid. Phenylic Acid. 1. Incompatible 
with collodion, forming a gelatinous mass. 2. Incompatible 
with hydrogen dioxide, becoming oxidized to pyrocatechin, 
hydroquinone, etc. 3. Incompatible with potassium perman- 
ganate, becoming oxidized to oxalic acid and carbon dioxide. 
4. Incompatible with nitric acid, becoming converted into 
picric acid. 5. It reduces silver salts. 6. In dilute solution 
(1 per cent.) it gives a violet blue color with ferric salts. 
7. Phenol forms a liquid or a soft mass when triturated with 
the following substances : acetanilid, antipyrin, betanaphthol, 
camphor, monobromated camphor, hydrated chloral, menthol, 
naphthalene, pyrogallol, resorcin, salol and thymol. 

Remember that carbolic * ' acid ' ' is not an acid, and will not 
for instance liberate C0 2 from a carbonate or a bicarbonate. 

Phenylis Salicylas. Being a salicylate it has the incompat- 



ALPHABETICAL SUMMARY 239 

ibilities of the latter ; but it generally needs first to be dissolved 
in an alcoholic menstruum, before it develops its reaction. It 
forms a liquid or soft mass when triturated with antipyrin 
(damp powder), camphor, monobromated camphor, chloral 
hydrate, exalgin, naphthalene, phenol, thymol and urethane. 

Plumbi Acetas. 1. Incompatible with potassium and sodium 
hydroxide (lead hydroxide), potassium and sodium carbonate 
(lead carbonate), borax (lead borate). 2. Incompatible with 
H 2 S0 4 or soluble sulphates, with HC1 or soluble chlorides, 
with soluble iodides, bromides and phosphates. 3. With tan- 
nic acid and pyrogallol. 4. With soluble benzoates and sali- 
cylates. 5. With many alkaloids. 6. Both on account of chem- 
ical reaction and the liberation of water of crystallization it 
forms a soft mass when rubbed with alum, zinc sulphate, 
phenol, acetanilid or salicylic acid. 

Potassii Permanganas. Potassium permanganate belongs 
to those few substances in medicine which should always be 
prescribed alone, if ordered in aqueous solution. It is very 
easily acted upon by a large number of chemicals, and prac- 
tically by all organic substances, and it is particularly the 
latter that must be avoided. 1. It is incompatible with hy- 
drogen dioxide, a very complex reaction taking place, with the 
result that both the permanganate and the dioxide are de- 
stroyed. 2. It is absolutely incompatible with glycerin, alco- 
hol and carbolic acid. 3. It should never be triturated, as an 
explosion may result, with sulphur, charcoal, sugar, tannic 
acid, picric acid or other organic substances. 

Potassii et Sodii Tartras. Rochelle Salt. Practically all 
acids decompose it, combining with the sodium radical and 
potassium bitartrate (cream of tartar) precipitating. 

Protargol. 1. Protargol in solution is precipitated by zinc 
sulphate, lead acetate, mercuric chloride, alum, and silver 
nitrate. 2. It is best never to prescribe it with alkaloids, as a 
precipitate is apt to occur. 3. The addition of glycerin to 
protargol is reprehensible, as a protargol solution containing 
glycerin is more irritating than a pure aqueous solution. 4. 



240 PRESCRIPTION INCOMPATIBILITIES 

Being an organic compound, protargol is incompatible with 
potassium permanganate. 

Pyramidon. 1. Gives a blue and violet color with spirit of 
nitrous ether. 2. With a solution of quinine bisulphate it 
gives a white precipitate. 3. If triturated with hydrated 
chloral it forms a soft mass. 

Pyrogallol. 1. Gives a purple color with lime water, which 
changes to dirty brown. 2. Gives a white precipitate gradual- 
ly turning dark with lead acetate. 3. Absolutely incompati- 
ble with potassium permanganate. 4. It forms a liquid or 
soft mass when triturated with antipyrine, camphor, phenol 
or menthol. 

Quinina. 1. Solutions of quinine salts are incompatible 
with, because precipitated by, soluble acetates, benzoates, 
salicylates, and tartrates. The corresponding acids do not 
cause a precipitate. 2. A precipitate is also said to be given 
by resorcin. 3. Triturated with thymol quinine sulphate 
produces a soft mass. 4. Of course solutions of quinine and 
its salts have all the general incompatibilities of alkaloids. 

Resorcinol. 1. Resorcin either in substance or in solution 
turns reddish, then dark when exposed to air and light. 2. It 
precipitates a solution of quinine sulphate or bisulphate. 3. 
When triturated with acetanilid, antipyrine, camphor, cam- 
phor monobromide, phenol or menthol it forms a liquid or soft 
mass. 

Salol. See Phenylis Salicylas. 

Saloquinine. This chemical is insoluble in water but soluble 
in acids, from which acid solution it is precipitated by alkaline 
hydroxides and carbonates and the other general alkaloidal 
precipitants. 

Santonin. Santonin is practically insoluble in water, but is 
soluble in the presence of alkalies, combining with the latter 
to form a santoninate. It turns yellow on exposure to light. 
An aqueous solution of sodium santoninate or any other 
santoninate is precipitated by tannic acid. 

Sapo. Soap is generally alkaline and when prescribed, as 



ALPHABETICAL SUMMARY 241 

it occasionally is, with calomel, it converts the latter into the 
black mercurous oxide. Soap is decomposed by mineral acids, 
the fatty acids being liberated. Metallic salts generally de- 
compose a solution of soap, the metallic oleate precipitating. 

Sodii Boras. Borax is alkaline in reaction and therefore 
tends to precipitate the alkaloids. Glycerin however by de- 
composing the borax (into boric acid and sodium borate) pre- 
vents this precipitation. As just stated, glycerin and borax 
react upon one another, but this cannot be considered an 
incompatibility. 

It is incompatible with mucilage of acacia, producing a thick 
gelatinous mass. Syrup prevents this precipitation. Tritu- 
rated with alum it forms a moist powder (due to the liberation 
of the large amount of water of crystallization). 

Sodii Perboras. When sodium perborate is dissolved in 
water hydrogen dioxide and sodium metaborate are formed. 

Sodii Phosphas. Being slightly alkaline it has a tendency 
to precipitate some alkaloids. When triturated with anti- 
pyrin or sodium salicylate, the powder becomes damp. It, of 
course, has the incompatibilities of the phosphates. 

Sodii Thiosulphas. (Sodium Hyposulphite). Incompatible 
with all acids, sulphur dioxide being evolved and sulphur pre- 
cipitating. It should not be triturated with chlorates, chro- 
mates, nitrates and permanganates, and other oxidizing sub- 
stances, as an explosion is liable to take place. It is absolutely 
incompatible with silver and mercury salts, reducing them to 
the metallic state or to sulphides. It reduces ferric salts to 
ferrous compounds. 

Spiritus Aetheris Nitrosi. Spirit of Nitrous Ether. Sweet 
Spirit of Niter. This is an important substance on account of 
its many incompatibilities and frequency of prescribing. 1. It 
is incompatible with antipyrin, producing iso-nitroso antipyrin 
of a grass-green color. Though this compound is not poison- 
ous, as it was once considered, still it is better not to dispense 
antipyrin with spirit of nitrous ether. 2. With acetanilid it 
gives a yellow solution. 3. It is incompatible with bromides 



242 PRESCRIPTION INCOMPATIBILITIES 

and particularly iodides, liberating bromine and iodine. 4. 
With sodium salicylate the mixture acquires a dark color. 5. 
With tannic acid and substances containing tannic acid, such 
as buchu, uva ursi, there is quite an evolution of gas (various 
oxides of nitrogen) and the bottle should not be stoppered 
until all the gas has escaped. These reactions take place prin- 
cipally with a spirit having an acid reaction, but it is very rare 
indeed to find a spirit of a perfectly neutral reaction. 

Spiritus Ammoniae Aromaticus. When mixed with water 
or aqueous menstrua turbidity results, due to the separation 
of the oils. It has all the incompatibilities of ammonia water 
and ammonium carbonate. 

Spiritus Glycerylis Nitratis. Nitroglycerin is so seldom 
prescribed with other drugs that there is no occasion to con- 
sider its incompatibilities. In fact it always should be pre- 
scribed alone, not only for pharmaceutical or chemical, but for 
therapeutic reasons. 

Strontium. Strontium salts are precipitated by alkaline 
hydroxides and carbonates, soluble phosphates, sulphates, 
(chromates), and citrates. 

Strychnina. See Alkaloids. Hydrochloric acid with a solu- 
tion of strychnine hydrochloride is said to give a precipitate. 
But this can only refer to the strong hydrochloric acid, and 
such a combination is not likely ever to be met with in practice. 

Sulphonethylmethanum. Trional. This hypnotic is not 
likely to be prescribed with substances with which it forms in- 
compatible combinations. One might remember that if trit- 
urated with hydrated chloral or urethane a soft mass will re- 
sult. 

Sulphonmethanum. Sulphonal. This is a very stable sub- 
stance and we know of no incompatibilities. It is claimed to 
liquefy when triturated with hydrated chloral. 

Sulphur. The only thing in incompatibilities to remember 
about sulphur is not to triturate it with a strong oxidizer, such 
as potassium permanganate or potassium chlorate. An ex- 
plosion may occur. 



ALPHABETICAL SUMMARY 243 

Theobrominae Sodio-Acetas. Agurin. 1. Incompatible with 
acids, which split up the salt. 2. Being alkaline it is apt to 
precipitate some of the alkaloids from the solutions of their 
salts. 

Theobrominae Sodio-SaJicylas. Diuretin. 1. Absolutely 
incompatible with acids which split up the salt. 2. Being 
alkaline it is apt to precipitate some of the alkaloids. 3. Being 
a salicylate it has the incompatibilities of a salicylate. 

Thymol. "When rubbed with acetanilid, antipyrin, camphor, 
monobromated camphor, carbolic acid, hydrated chloral, men- 
thol, salol, or quinine sulphate, thymol forms a liquid or a soft 
mass. 

Thymolis Iodidum. Aristol. 1. It is not advisable to 
triturate it strongly with calomel, as the liberated iodine may 
convert a portion of the calomel into mercuric iodide. 2. Con- 
trary to careless statements, it is quite compatible with starch. 

Tinctura Iodi. The old pharmacopeial tincture would give 
a precipitate when mixed with water or aqueous preparations. 
The tincture of the new pharmacopeia, however, containing as 
it does potassium iodide, is perfectly miscible with aqueous 
menstrua. Of course the tincture has the incompatibilities of 
iodine and potassium iodide (q. v.), modified by the alcohol. 

Trinitrophenol. See Acidum Picricum. 

Trional. See Sulphonethylmethanum. 

Urea. It is not likely that urea will be prescribed in com- 
bination with other substances, but we might mention that 
when triturated with hydrated chloral it produces a soft mass 
or a liquid. 

Zinc Salts. Soluble zinc salts are incompatible with soluble 
hydroxides, carbonates, phosphates, and with borax. With 
tannic acid zinc salts give a precipitate only in concentrated 
solution. 



INDEX 

Prescription No. 

A CACIA + borax + syrup -f water 227 

***' -j- borax -j- water 226 

Acidmn acetylsalicylicum -{- hexamethylenamine 228 

-j- potass, iodide 245 

Aeidum benzoicum -(- lime water 266 

Aeidum boricum -\- sol. lead subacetate 92 

(excessive quantity) -|- water 98 

Aeidum earbolicum. See Phenol. 

Aeidum ehromicum -\- alcohol 50 

-\- hydrogen dioxide 163 

Aeidum citricum -|- sod. salicylate 87 

Aeidum gallieum -J- ferrous sulphate -f- copper sulphate -|- zinc 

sulphate 267 

Aeidum hydr. dilutum 247 

Aeidum hydroehloricum dilutum -(- comp. rhubarb powder 261 

-(- potassium chlorate 60 

-f- sodium sulphite 132 

Aeidum hydrocyan. dil 255 

Aeidum nitrohydroehloricum -j- potassium iodide 195 

Aeidum phenylcinchoninicum ~\- hexamethylenamine 229 

Aeidum phosphoricum dilutum -|- ferric pyrophosphate 83 

Aeidum picricum -j- cocaine hydrochlor 86 

Aeidum salicylicum (excessive quantity ) 122 

-j- calomel -|- lime water 188 

-j- gljTeerin + water 230, 251 

-j- lime water 187 

-j- mass of ferrous carbonate 323 

-f- potassium permanganate 184 

-j- sod. bicarbonate 69, 70 

-f- tannic ac. -J- alum -j- kaolin 373 

(excessive quantity) -f- sod. bicarbonate 220 

(excessive quantity) -f- water 97 

245 



246 INDEX 

Prescription No. 

Aeidum sulphuricum arom. -\- eomp. chalk powder -|- water. . 260 

Aeidum sulphurosum -}- hydrogen peroxide 412 

Aeidum tannieum -(- alum 211 

_|_ argyrol 281 

-f- bismuth subnitrate 293 

-f- copperas -f- alum 268 

-(- morphine sulphate > 1 

-j- potassium chlorate 84 

-f-potassiuni permanganate 85 

-|- sol. of lime (lime water) 9 

+ zinc sulph. -|- water 371 

Aeetanilid -f- resorcin 257 

-f- spir. nitrous ether 256 

-j- thymol -j- resorcin 258 

Acetozone -|- water 259 

Acetphenetidinum -)- exalgin 319 

-|- tr. ferric chloride 234 

Acidol. See Betainae Hydrochl. 

Aconitinae nitras -j- collodium 21 

Adrenalin chlor. -\- silver nitrate 240 

-(- hydrogen dioxide 317 

Adrenalini sol. -f- pinoleum 379 

Agurin -f- sod. salicyl. -)- syr. of lemon 269 

-f- sparteine sulph. -|- syrup 366 

Airol + calomel 296 

-j- calomel -j- lime water 388 

Alcohol -f- chromic acid 50 

Alkaloidal salts -j- olive oil 96 

-|- petrolatum 350 

Alkaloids -f- mercauro 159 

-j- mercuric chloride -j- potassium iodide 55, 56 

Alumen -f- borax -\- chloroform water 270 

-(- borax -j- glycerin -|- water 244 

-(- copperas -(- tannic acid 268 

+ lead acetate 105, 106 

-f- lead acetate (in powders) 107 

-j- lime water 271 

-}- sodium borate (in powder) 357 

+ tannic acid 211 



INDEX 247 

Prescription No. 

Alypinum -j- Dobell's solution 273 

-j- silver nitrate 272 

Ammonii benzoas -f- tr. ferric chloride 194 

Ammonii carbonas -\- calomel 147 

-f- morphine sulphate 2 

-(- quinin. bisulphate 18 

-f- syr. ipecac 67 

-j- syr. squills 67 

Ammonii chloridum -f- codeine 185 

Ammonium sulpho-ichthyol. See IchtJiyol. 

Amylum -(- europhen 385 

-j- thymol iodide 369 

Antikamnia -(- antipyrin -\~ phenacetin -|- acetanilid -|- phenal- 

gin -J- caffeine 375 

-{-< morph. sulph. -f- quin. sulph. -j- arom. sulph. ac 149 

Antim. et potass, tartr. -j- tannic ac. (syr. wild cherry) 3 

Antipyrina -\- calomel 37 

-\- calomel -f- sod. bicarbon . . 157 

-\- piperazin in powders 274 

-f- resorcin -j- phenacetin 196 

+ salol -|- camphor 352 

-(- sodium salicylate 25 

-f- spir. nitrous ether 24 

-J- tannic acid (in syr. wild cherry) 23 

-j- tr. ferric chloride 65 

Aqua ammoniae -{- collodion 137 

-j- tr. iodine -f- soap liniment 339 

Aqua ammoniae f ortior -\- ether -j- collodion -j- tr. iodine 138 

Aqua camphorae -\- bromides 17 

Aqua cinnamomi -\- tinct. of ferric chloride 7 

Aqua crotonis -|- magnes. sulph 312 

Aqua gaultheriae -j- tr. of ferric chloride 64 

Argenti nitras -\- alypin 272 

-\- ext. glycyrr 45 

-|- organic substances 45, 46, 47 

-\- organic substances (in liquid form) 204 

-j- organic substances (in powder form) 203 

-\- phenol 351 

-j- potass, permanganate 154 



248 INDEX 

Prescription No. 
-f- powd. althea 45 

-|- protargol -j- lead acetate 353 

-f- sodium borate 276 

-J- sodium chloride 48 

-f- sol. adrenalin chlor 240 

-j- sol. potass, arsenite 77 

-f- syr. hypophosphites 20 

Argonin -(- tannic acid 278 

+ zinc sulphate 277 

+ zinc sulph. -\- lead acetate -j- bismuth subnitrate 279 

Argyrol -f- mercuric chloride 282 

-J- iodine 207 

+ potassium iodide 407 

-)- tannic acid 281 

-|- zinc sulphate 280 

Aristol. See Thymolis Iodidum 370 

Asaprol -\- nitrohydrochlor ac 299 

Aspirin -J- formin. See also Acidum Acetyl Salicylicum 228 

-f- potass, iodide 245 

-|- quinine sulphate 413 

-|-urotropin 228 

Atophan -|- urotropin 229 

Atropinae sulphas -|- collodion 21 

(excessive dose) 11 

-\- potassium iodide 11 

Auri et sodii chloridum -|- sol. potassium arsenite 286 

T) ALSAMUM Peruvianum + hydrogen dioxide 168 

D -f iodoform + lard 338 

Barii sulph 313 

Betainae hydrochloridum -|- pepsin 394 

Bismuthi et ammonii citras -f- hydrochloric acid 80 

-|- hydrochlor. acid -|- pepsin 291 

Bismuthi salicylas -|- hydrochloric acid 419 

-j- mist, rhei et sodae 420 

-j- sodium bicarbonate 420 

Bismuthi subnitras -}- calcined magnesia 181 

-)- potassium iodide 292 

-j- sod. bicarbon 204 



INDEX 249 

Prescription No. 

+ sodium bicarbonate 41 

-f- sod. bicarbonate (in pill form) 49 

-f- tannic acid -f- syrup -|- water 293 

Bismuthi subsalicylas. See Bismuthi Salicylas. 

-j- nitrohydrochlor. ac 298 

Brometone -\- pyramidon 530 

/^ AFFEINA citr. -(- sodium bromide -f- strontium bromide. . . 294 

-j- sodium salicylate 406 

Caffeina citrata efferv. — dispensed in paper box 295 

Caffeinae-sodio benzoas -f- dil. hydrochlor. ac. -|- pepsin 297 

Calcii glycerinophosphas -|- potass, glycerophos. -|- sod. glycero- 

phos. in powders 265 

Calc. chlor. -\- comp. chalk powder 314 

Calomel. See Hydrarg. Chlor. Mite. 

Calx chlorinata -|- glycerin -}- water 383 

Calx sulphurata (in powders) 300 

Camphora (in pills) 536 

+ chloral 305 

-f- chloral -j- phenol 306 

-|- menthol 35 

-\- menthol (in pills) 536 

+ phenol 302 

-|- syr. wild cherry -(- water 537 

-f- salol -j- antipyrin 352 

Camphora monobrom -j- chloral 303 

Camphora monobromata -[- chloral -f- lupulin 180 

Cannabis indica -j- water 4 

Carbo anim. -\- tr. nux vom. -|- comp. tr. cinchona 304 

Carbolic acid. See Phenol. 

Chinosol -|- mercuric chloride 308 

Chloralum hydratum -\- camphor 303, 305 

+ camphor -j- phenol 306 

-|- sulphonal 365 

-f- trional 363 

-j- monobrom. camphor -\- lupulin 180 

Chloramine T -\- hydrogen dioxide 396 

Chlorazene + boric ac 395 

Chloretone -|- menthol 307 



250 INDEX 

Prescription Na. 
Coeainae hydrochloridum -|- camphor -\- chloral 381 

-f- collodion 21 

-f- liquid petrolatum 99 

-]- morph. sulph. -)- atropine sulph. -\- petrolatum 350 

-\- picric acid 86 

-f- quin. sulph. -(- tannic ac. -f- menthol -)- rose water. . . 225 

-|- sodium borate 28 

Codeina -f- ammon. chloride 185 

Collodium -f- alkaloidal salts 21 

-f- ammonia water 137 

-\- ammonia water -|- ether -\- tr. iodine 138 

-f- creosote 74 

-|- phenol 74 

-|- tr. iodine ■ 315 

+ zinc chloride 140 

Creosoti carbonas -|- quin. hydrobrom. -j- camphor monobrom. 

+ ergotin 533 

Creosotum -j- balsam tolu 540 

+ collodion 74 

-|- guaiacol (in pills) 321 

-|- guaiacol -\- creosotal -\- duotal -f- thiocol (in powders) 322 
-f- tr. ferric chloride 214 

Cupri sulphas -|- gallic acid 267 

-f- sodium bicarbonate 170 

pvERMATOL + nitrohydrochloric acid 299 

"^"^ Diuretinum. See Theobrom. Sodio-Salicylas. 

Diuretinum -f- phosphoric acid 128 

-\- sol. iron and ammon. acet 367 

+ tr. ferric chloride 126 

+ water 127 



TjiPINEPHRIN-f mercuric chloride 318 

■^ Ess. pepsini -f- dih hydrochlor. ac. -\- magma magnesia . . . 389 

Europhen -f- amylum 385 

-|- cold cream 387 

Exalgin -f- phenacetin 319 

-f- phenacetin -|- sod. salicyl 320 

Ext. hyoscyamus -j- tannic ac. -f- ^ ar( i •••<•* » 113 



INDEX 251 

Prescription No. 

T^ EL bovis -|- oil turpentine -f- glycerin 541 

*- Ferri et ammonii citras -|- potass, iodide 213 

Ferri et quininae citras -|- potassium iodide 218 

-|- sol. ammonium acetate 160 

Ferri phosphas -|- ac. phosphor, dil Ill 

sol. -\- ac. phosphoric 112 

Ferri pyrophosphas -(- ac. phosphor, dil 83 

Ferri sulphas -\- gallic acid , 267 

-j- sod. carbon 324 

Ferrum dialysatum -f- sol. potassium arsenite 79 

Fluidext. buchu -f- spir. nitrous ether 72 

-f- water 336 

Fluidext. cannabis indicae -|- water 4 

Fluidext. glycyrrhizae -\- dil. sulphur, ac 58 

Fluidext. hyoscyami -f- potass, bicarbon. -|- water. 336 

Fluidext. uvae ursi -\- spir. nitrous ether 71 

/^ILYCERINUM + hydrogen dioxide 162 

^** -(- liquid petrolatum -|- menthol 347 

-|- olive oil -(- menthol 346 

-j- potass, permang 51 

-j- resorcin 409 

-j- sodium borate 94 

-f- sod. bor. -(- sod. bicarb 15 

Glyceritum ac. tannici -|- lead acetate 139 

+ sol. of lime 10 

Glyceri. boroglycerini -\- water 114 

Guaiaeol -f- creosote (in pills) 321 

crystall. (in pills) 326 

TJALAZONE tablets 397 

Helmitol -|- potass, bicarbon. -f- sol. potass, hydroxide. . . 392 

Heroina -J- ammon. carbon. -\- syr. wild cherry 316 

Heroini hydrochlor. -f- quin. hydrochlor. -(- creosote carbonate 

(in capsules) 532 

Hexamethylenamina -f- sodium acid phosphate or sodium bi- 

phosphate 400 

Holocainae hydrochlor. -{- borax 539 

Hydrargyri chloridum -\- sugar milk 377 



252 INDEX 

Prescription No. 

Hydrargyri ehloridum corrosivum -|- argyrol -f- zinc sulphate. . 282 

-f- chinosol 308 

-f- epinephrin 318 

-(- Fowler's solution 330 

-f- hydrogen dioxide 151 

-f- lime water 332 

-|- lime water -f- lead water 75 

-{- lime water -|- muc. of acacia 76 

-f- potass, iodide 328 

-)- potass, iodide -[- alkaloids 55, 56 

-)- potass, iodide -f- comp. syr. sarsap 329 

-|- potass, iodide -J- iron and amm. citrate -f- tr. nux vom. 

+ comp. tr. cinchona 216 

-|- potass, iod. -|~ tr. cinchona comp 56 

-\- potass, permanganate -|- comp. sol. cresol 231 

-|- potass, sulphurata .- 201 

-j- pyrogallol 380 

-f- sod. borate 164 

-|- sol. potass, arsenite 121 

-j- syr. hypophosphites 19 

-j- tr. iodine 414 

Hydrargyri ehloridum mite -)- ammonium carbonate 147, 176 

-|- ammonium chloride 175 

-}- antipyrine 37 

-f- antipyrine -(- sod. bicarbon 157 

-|- antipyrine -|-. sodium bromide -|- sodium phosphate -\- 

sod. bicarb, -f- caffeine citr 219 

-)- hydrochloric ac 177 

+ hydrogen dioxide 150 

-]- iodine ointment 334 

-|- iodoform 145 

-\- lime water 333 

-j- potassium bromide 62 

-|- potassium chlorate 310 

-(- potassium chlorate -|- bism. subnitr 311 

-)- potassium iodide 246 

-|- salicylic ac. -(- lime water 188 

+ soap 143 

-f- sodium bicarbonate 157 



INDEX 253 

Prescription No. 

-\- sodium chloride 215 

-\- syr. of rhubarb 178 

-j- thymol iodide 370 

Hydrargyri iodidum flavum -f- potassium iodide 172 

-|- potassium iodide (in pill form) 173 

Hydrargyri oxidum flavum -(- cocain. hydrochl 27 

Hydrargyri salieylas -|- potassium iodide 398 

+ water 335 

Hydrargyrum ammoniatum -(- sulphur -)- potass, carbon. -[- lard 327 

Hydrogen dioxide. See Liq. Hydrogenii Dioxidi. 

Hydrogen perovide. See Liq. Hydrogenii Dioxidi. 

Hypophosphites -|- tr. ferric chloride 189 

T CHTHYOL -f acidum hydrochloricum 116 

-f- alcoholic tinctures 117 

-f- cocaine hydrochlor 120 

+ mercuric chloride -\- potass, iodide 118 

-\- quin. sulph 119 

-}- strychn. sulph. -\- quinin. sulph 119 

-f- zinc sulphate 337 

Iocamfen -\- water 386 

Iodoformum -)- bals. of Peru -f- lard 338 

+' calomel 145 

-J- ether -|- hydrogen dioxide 153 

+ hydrogen dioxide 152 

-f- olive oil -(- hydrogen dioxide 166 

Iodum + alcohol -|- oil turpentine 131 

_j_ argyrol 407 

+ glycerin 130 

+ woolfat 109 



K 



AOLINUM + salicylic ac. -\- tannic ac. + alum 373 



IQUOR acidi arsenosi -|- syr. hypophosphites <.. 285 

^ + tr. ferric chloride 124 

Liquor ammonii acetatis -f- tr. ferric chloride 78 

Liq. arseni et hydrarg. iodidi -\- strychn. sulph 283 

-(- strychn. sulph. -j- quin. sulph 284 

Liquor calcis -j- glycerite tannic acid 10 



254 INDEX 

Prescription No. 

-|- hydrogen dioxide , 5 

-|- mercuric chloride -f- l e& d water 75 

-f- sod. benz 250 

-\- tannic acid 9 

Liquor creosolis comp. -f- mercuric chloride -|- potass, perman- 

gan 231 

Liquor f erri dialysati -\- muc. acacia -|- syr. raspberry -j- water 134 
-f- hydrogen dioxide 341 

Liquor hydrogenii dioxidi -\- adrenalin 317 

+ balsam of Peru . 168 

-\- bismuth subnitrate 167 

+ calomel 150 

-|- chromic acid 163 

-j- ether -j- iodoform . 153 

+ glycerin 162, 238 

-\- hypochlorites 148 

-)- iodoform 152 

-|- iodoform -f- olive oil 166 

-f- Labarraque's solution 148 

-(- lime water 5 

-f- mercuric chloride 151 

-|- phenol -f- tr. ferric chloride 182 

-|- potassa sulphurata 200 

-|- potassium permanganate 222 

-j- sol. formaldehyde 341 

-J- sulphurous acid 1 412 

-\- syr. hydriodic acid 221 

-)- tr. arnica -j- fl. ex. calendula 169 

+ tr. iodine 192 

-|- zinc sulphate 167 

Liquor plumbi subacetatis -)- boric acid 92 

-j- muc. acacia 68, 123 

-f tr. iodine 382 

-J- tr. opium 146 

-|- mercuric chloride -f- lime water 75 

Liquor potassii arsenitis -\- dialyzed iron 79 

-j- gold and sodium chloride 286 

-\- mercuric chloride 121, 330 

~|- morphine sulphate 22 



INDEX 255 

Prescription No. 

-f- silver nitrate 77 

-)- syr. ferrous iodide " 417 

-}- syr. ferrous iodide -{- Fowler's solution -(- elix. calisaya 115 

-(- syr. ferrous iodide -|- tr. nux vomica 210 

-\- tr. ferric chloride 81 

Liq. sodae chlorin -|- hydrogen dioxide 148 

Lithii citras -|- sodium phosphate 342 

-|- strontium bromide 103 

IX/fAGNESII oxidum -|- bismuth subnitrate -(- pancreatin 181 

1V1 _|_ water 13 

Magnesii sulphas -)- aqua crotonis 312 

-|- sodium phosphate 343 

-f- spir. peppermint -(- water 156 

Massa ferri carbonatis -j- potassium carbonate 384 

-f- salicylic ac 323 

Menthol + alcohol -f- water 344 

-j- camphor 35 

-)- chloretone 307 

-j- cocaine hydrochl. -\- quin. sulph. -J- tannic ac 225 

-|- eucalyptol -j- zinc sulph. -j- liq. albolene 378 

-j- olive oil -f- glycerin 346 

-j- thymol -j- eucalyptol -|- cocaine hydrochl. -j- liquid pe- 
trolatum 99 

Mercauro -|- strychn. sulph. -j- atropine sulph 159 

Mist, rhei et sodae -f- dil. hydrochloric acid 289 

-f- pepsin 290 

Morphihae acetas -J- oil of turpentine 198 

Morphinae hydrochlor. -j- potassium cyanide 158 

Morphinae sulphas -\- ammonium carbonate 2 

-\- antikamnia -|- quin. sulpht. arom. sulph. ac 149 

-f- arom. spir. ammonia 36 

-|- Fowler's solution 22 

-j- oleic acid 100 

-(- potass, iodide 59 

-(- sol. potass, hydrox 90 

-f- spir. nitrous ether 89 

-f- strontium bromide 102 

-f- syr. senega 2 



256 INDEX 

Prescription No. 
-|- syr. wild cherry 3 

-|- tannic acid '. 1 

+ tr. capsicum -\- ether 206 

-f- tr. ferric chloride 171 

Muc. acaciae -j- s °l- l ea d subacetate 68, 123 

+ tr. iodine -f- alcohol , 239 

/^LEUM olivae + glycerin 346 

^^^ Oleum terebinth. -|- morph. acet 198 

Oleum tiglii -\- ol. ricini -f- glycerin 186 

Oleum ricini -(- glycerin 186 

Orthof orm -j- onv e oil 527 

pANCREATINUM + dil. hydrochloric acid 348 

+ pepsin -|- dil. hydrochlor. ac 348 

Pepsinuin -|- pancreatin -f- lactopeptine -\- hydrochlor. acid -\- 

mist. rhei et sodae 416 

-f- ac. hydrochlor. -\- bismuth and ammonium citrate .... 291 

-f- alcoholic tinctures 212 

-f- betaine hydrochlor 394 

-|- mixt. rhubarb and soda 290 

-\- pancreatin -(- dil. hydrochlor. ac 348 

-f- resorcin -|- salol 209 

-f- sodium bicarbonate 208 

Peroxide of hydrogen. See Liq. Hydrogenii Dioxidi. 

Petrolatum liquidum -\- glycerin -}- menthol 347 

Phenacetin -|- exalgin 319 

-|- exalgin -|- sod. salicyl 320 

Phenol -J- camphor 302 

-}- camphor -j- chloral 306 

-j- collodion 74 

excessive quantity 53 

-)- hydrogen dioxide -|- tr. ferric chloride 182 

-f- potassium permanganate 183 

-\- silver nitrate 351 

-f- thymol -j- camphor -j- boric ac 368 

-|- tr. iodine -j- mue. acacia -|- alcohol 239 

Phenylis salicylas -f- camphor -|- antipyrin 352 

-j- spir. nitrous ether -j- tr. ferric chloride 135 



INDEX 257 

Prescription No. 

Piperazina -f- antipyrin, in powders 274 

(in powders) 349 

Plumbi acetas -f- alum 105, 106 

-f- alum (in powder) 107 

-f- glycerite of tannic acid 139 

-f- potassium iodide 165 

-j- sodium borate 93 

-f- sodium borate + glycerin 94 

-|- zinc sulphate 54 

-f- zinc sulphate (in powder form) 38 

Polypharmacy, example of 390 

Potassa sulphurata -f- hydrogen dioxide 200 

-j- mercuric chloride 201 

-f- zinc sulphate -|- lead water 217 

Potassii bromidum -j- calomel 62 

-|- camphor water 17 

-j- potass, citrate -f- spir. chloroform 241 

Potassii chloras -|- calomel 310 

(excessive quantity) -\- tr. ferr. chlor. -|- glycerin -f- wa- 
ter 61 

-|- hydrochloric acid 60 

-f- mercurous chloride -f- bism. subnitrate 311 

-f- sodium thiosulphate 309 

-f- tannic acid 84 

Potassii cyanidum -|- morph. sulph 158 

Potassii glycerinophosphas, in capsules 264 

Potassii hypophosphis -|- tr. ferric chloride 189 

Potassii iodidum -j- argyrol 407 

-|- bismuth subnitrate 292 

-{- dil. sulphuric acid 40 

+ lard 110 

-|- lead acetate 165 

-|- nitro hydrochloric ac 195 

-f- quin. sulph. -)- dil. sulphur, acid 40 

-\- sodium iodide -(- spir. nitrous ether 360 

-\- sod. thiosulph 359 

-j- spir. nitrous ether 26, 523 

-f- syr. ferr. iodide 73 



258 INDEX 

Prescription No. 

+ tartaric acid 144 

-f- tine, of ferric chloride 16 

Potassii permanganos -|- ferrous sulphate -\- dil. sulphuric acid . 193 

-f- glycerin 51 

-{- hydrogen dioxide 222 

-|- morph. sulph. -f- ext. glycyrr 88 

-}- organic substances (in pill form) 52 

+ phenol 183 

-f- pyrogallol 355 

-|- salicylic acid 184 

-f- silver nitrate 154 

-|- tannic acid 85 

-j- thymol -f- alcohol 372 

Potassii et sodii tartras -f- ac id + alcohol 161 

-\- arom. sulphur, ac 252 

-f- tr. ferric chloride 161 

Protargol -(- cocaine hydrochlor 411 

-f- lead acetate -f- silver nitrate 353 

-j- water 235 

-f- zinc sulphate 6 

Pulvis cretae comp. -f- elixir of vitriol 260 

Pulv. rhei comp. -f- dil. hydrochlor. ac 261 

Pyramidon -j- brometone 530 

-f- spir. nitrous ether 354 

Pyrogallol -j- mercuric chloride 380 

-|- potassium permanganate 355 

QUININAE bisulphas. -|- ammonium carbonate 18 

-f- resorcin 356 

-f- sodium benzoate 248 

Quininae hydrochloridum -j- ammonium carbonate 205 

Quinin. sulphas -f- acid sulph. dil. -f- fluid ext. glycyrrhiza .... 58 

-|- aspirin 413 

-f- arom. spir. ammonia -f- tr. ferric chloride 82 

-f- potassium iodide -\- dil. sulphur, acid 40 

-j- potass, iodide -|- tartaric acid 144 

-\- sod. acetate -(- dil. sulph. ac 30 

-f- sodium benzoate 249 



R 



INDEX 259 

Prescription No. 

-f- sod. salicyl. -f- dil. sulphur, dil 29 

— |- tr. ferric chloride -f- dil. sulph. acid 34 

ESORCINOL + acetanilid 257 

-f- acetanilid -J- thymol 258 

-|- antipyrine -f- phenacetin 196 

-j- benzoinol 542 

-j- glycerin 409 

-(- quin. bisulph 356 

-|- petrolatum liquidum 408 

-|- tr. ferric chloride 197 

O ALICINUM -f quin. sulph. + dil. sulphuric ac 224 

^ Saliformin -j- water 393 

Salol. See Phenyl Salicylas. 

Salophen -f- sodium bicarbonate 399 

Santoninum -j- calomel 391 

Sapo -(- calomel 143 

Shotgun prescription, example of 390 

Sodii acetas -)- quin. sulph. -j- dil. sulphuric acid 30 

Sodii benzoas -j- quin. bisulph 248 

+ citric acid 288 

-(- dil. phosph. ac. -|- syr. of lemon 287 

-|- lime water 250 

-f- quinine sulph 249 

-j- syrup of lemon -|- syr. of citric acid 254 

-(- tr. ferric chloride 194 

Sodii bicarbonas, 25 per cent, solution 63 

-|- ac. salicyl 69, 70 

-f- bismuth subnitrate 41 

-j- strontium bromide 410 

-j- sod. bor. -(- glycerin 15 

Sodii boras -|- acacia -j- syrup -\- water 227 

-f- acacia -)- water 226 

-\- ac. salicyl. -{- glycerin -\- water 230 

-j- alum -(- glycerin -\- water 244 

-\- alum (in powder) 357 

-|- cocaine hydrochlor 28 

-J- mercuric chloride 164 



260 INDEX 

Prescription No. 

-f- lead acetate 93 

-J- lead acetate -\- glycerin 94 

-f- sod. bicarb. -|- glycerin 15 

~f- zinc sulphate -f- glycerin 95 

Sodii bromidum -f- camphor water 17 

Sodii glycerinophosphas — in powders 263 

-j- quin. sulph. -j- strychn. sulph. (in pills) 325 

Sodii hyposulphis. See Sodii Thio sulphas. 

Sodii iodidum -f- elix. iron, quinine and strychnine phosph .... 528 

Sodii perboras -|- water 358 

Sodii phosphas -J- lithium citrate 342 

-f- magn. sulph 343 

Sodii salicylas -j- antipyrin 25 

-f- citrated caffeine 406 

-f- citric acid -|- syr. of raspberry 87 

-|- dil. sulph. ac 29 

-f- dil. sulph. ac. -|- quin. sulph 29 

-j- hexa -|- spir. nitrous ether -f- water 232 

-f- sodium bicarbonate 155 

-|- spir. nitrous ether ; 66 

-)- syrup of lemon 253 

-\- syr. of raspberry 39 

-\- tr. ferric chloride 33 

Sodii sulphis -j- hydrochloric ac 132 

Sodii thiosulphas -|- potass, chlorate 309 

-|- sulphuric acid 207 

Sol. Magendie -f- Fowler's solution 22 

-|- potass, iodide 59 

Sol. morphinae sulph 376 

Sparteinae sulphas (in tablets) 531 

Spir. aetheris nitrosi -f- acetanilid 256 

-|- antipyrin 24 

+ A. ext. buchu 72 

-|- fl. ext. uva ursi 71 

+ iodides 360 

-\- morph. sulph 89 

-j- potassium iodide ; . . 26 

-(- pyramidan 354 

-J- sod. salicyl , . , . . 66 



INDEX 261 

Prescription No. 

Spir. ammoniae arom'aticus -\- morph. sulph 36 

-f- sod. brom. + water 361 

-J- sol. of lime 14 

+ syr. of nutgalls 174 

-j- tr. ferric chlor. -|- quin. sulph 82 

-}- tr. ferric chloride -f- sod. salicyl. -(- quin. sulph 125 

-|- water 14 

Spir. menthae piper. + water 14 

Spir. camphorae -j- peppermint water 243 

+ water 301 

Spir. chloroformi -j- potass, brom. -j- potass, citr. -}- water 241 

Spir. pimentae -f- tine, of ferric chloride 8 

Strontii bromidum (in powders) 101 

-f lithium citrate 103 

-f- mixt. rhubarb and soda 410 

-f- morph. sulph 102 

-j- sod. bicarb 104, 410 

Strontii iodidum -|- morph. sulph 102 

Strychninae hydrochlor. -f- dil. hydrochlor. ac 362 

Strychninae sulphas -|- Donovan's solution 283 

-f- Fowler's sol. -j- syr. ferrous iodide -\- elixir calisaya . . 115 

~\- potassium bromide 42 

-f- potassium bromide -j- spir. f rumenti 43 

quantity for 20 pills made into one 262 

-f- quin. sulph. -(- sod. glycerophosph 325 

-|- sodium phosphate 44 

-J- sol. potass, hydrox 91 

Sulphonal -f- chloral 365 

+ trional -\- urethane 364 

Syr. acidi hydriodici -|- hydrogen dioxide 221 

Syr. f erri iodidi -j- Fowler's solution 210, 417 

-\- potass, iodide 73 

Syr. gallae -\- arom. spir. ammonia 174 

Syr. hypophosphitum compos, ~f- sol. arsenous acid 285 

Syr. hypophosphitum -(- mercuric chloride 19 

+ silver nitrate 20 

-f- tr. ferric chloride 190 

-|- tr. ferric chloride -f- water 191 

Syr. rhei -\- calomel 178 



262 INDEX 

Prescription No. 
rp HEOBROMINAE-SODII salieylas + acids 128 

-J- mercuric chloride -j- potassium iodide 233 

-j- tr. of iron 126 

Theobromine-sodium acetate -j- sparteine sulph. -f- syrup -|- 

strychn. sulph 366 

Thymol -\- acetanilid -j- resorein 258 

-|- camphor -f- phenol -j- boric ac 368 

Thymolis iodidum -(- calomel 370 

+ starch 369 

Tinctura digitalis -|- tr. ferric chloride 202 

-|- tr. strophanthus -\- sparteine sulph. -(- stryehn. sulph. 374 

Tinctura ferri chloridi -f- ammon. benzoate -\- sod. benzoate 194 

-|- ammon. tr. valerian 199 

-J- antipyrin 65 

-|- cinnamon water 7 

-|- creosote water 214 

-|- hypophosphites 189 

-j- methyl salicyl 345 

-|- morph. sulph 171 

-\- muc. acacia -|- syrup -f- water 133 

-|- oil of wintergreen 64 

-j- phenacetin 234 

-|- phenol -|- hydrogen dioxide 182 

-f- potassium bromide 179 

-f- potassium iodide 16 

-j- quin. sulph. -j- arom. spir. ammonia 82 

-(- resorein 197 

-f- salol -(- spir. nitrous ether 135 

-|- sodium bromide 179 

-|- sod. salicylate 33 

-\- sol. ammon. acetate 78 

-)- sol. arsenic tri oxide -|- quin. sulph. -\- inf. cinchona. . . 124 

-f- sol. potass, arsenite 81 

-j- spir. pimenta 8 

-f- syr. hypophosphites -f- water 191 

-\- tr. cinchona 57 

-f-tr. digitalis 202 

-f- tr. gentian 194 

-|- tr. nux. vom. -(- tr. digitalis -j- quin. sulph. -|- sod. 

salicyl. -}- arom. spir. ammonia 125 



INDEX 263 

Prescription No. 

Tinctura guaiaci -(- water 11 

Tinctura iodi -\- albolene 525 

-j- ammonia water 526 

-\- ammonia water -j- soap liniment 339 

-j- collodion 315 

-f- glycerin -j- water 129 

-\- hydrogen dioxide 192 

-j- mercuric chloride 414 

+ sol. lead subacetate 382 

Tinctura nucis vom. -j- charcoal 304 

-j- comp. tr. of gentian 41S 

-j- Fowler's solution -j- syr. ferrous iodide -|- elix. ealisaya 115 
-j- tr. digitalis -\- tr. ferric chloride -|- phosphoric ac. -f- 

water 141 

-f- water 418 

Tinctura opii -J- sol. lead subacetate 146 

Tinctura Valerianae ammoniata -(- tr. ferric chloride 199 

Trinitrophenol. See Acidum Picricum. 

Trional -f chloral 363 

-f- sulphonal -f- urethane 364 

T T XG. hydrargyri -j- iodine oint 340 

^ Ung. iodi -f- calomel 334 

-j- ung. hydrargyri 340 

Ung. zinci ox. -j- lime water 242 

Urethan -j- trional -(- sulphonal 364 

Urotropin -f- atophan 229 

^INCI chloridum + collodion 140 

Zinci iodidum -j- water 136 

Zinci phosphidum -\- phosphoric acid 142 

Zinci sulphas -|- argyrol 280 

-f- bism. subnitr. -j- lead water -j- liver of sulphur 217 

-\- lead acetate 54 

-j- lead acetate (in powder form) 38 

-j- liq. albolene 378 

-(- protargol 6 

+ sod. borate 108 

+ sodium borate -f- glycerin 95 

-|- tannic ae. -(- water 371 



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of the most useful, one of the most valuable books that 
have ever been published. A gratifyingly large num- 
ber of physicians have told us that the book not only 
helped them to treat successfully sexual weakness and 
other disorders in their patients or in themselves, but 
that it opened their eyes to the significance of many 
things which they did not understand before. 

Those who have read the book know its value and 
importance ; those who have not may be interested to 
read what the medical journals have to say about it, 
Here are a few extracts: 

No American authority has given more serious thought 
to the subject of sexual diseases than the author of this 
volume; he has given to us in it the best that in him lies. 
No physician who has had to combat this distressing condi- 
tion, and those conditions dependent upon it, has any doubt 
of its serious importance. And we all recognize the weak- 

Dr. Robinson take? 



SEXUAL IMPOTENCE 

a sensible view of things which have not been sensibly con- 
sidered; nowhere has he shown this to better advantage 
than in this volume on a difficult subject. 

— Medical Fortnightly. 

Dr. Robinson discusses the numerous phases of this sub- 
ject, in both sexes, clearly and in detail. He tells no lies 
to conform to moral, social and religious ideals, and con- 
sequently those who differ with him in beliefs or in pre- 
tensions may censure him as immoral. In some of these 
points there is opportunity for difference of opinion, but 
on the whole we think that Dr. Robinson has expressed 
what the majority of physicians believe, tho not necessarily 
the opinion most frequently published. Pretty nearly 
every conceivable sexual abnormality, physical or psychic 
is at least alluded to. If we were to select any one feature 
of this work for special mention, it would be the uniform 
common sense of the author. — Buffalo Medical Journal. 

This book is not by any means a rehash of some other 
book or a resume of several. This treatise is interesting 
and valuable, and the author is absolutely honest and fear- 
less in his opinions. A unique and helpful feature is the 
case reports which illustrate every phase of sexual dis- 
order. — Indianapolis Medical Journal. 

Dr. Robinson deals with the subject in a dignified, scien- 
tific way, that will be helpful to the physician who hai» 
judgment enough to realize that he is as responsible for 
functions around which a modern, sham, conventional 
modesty has thrown a hiatus of folly as he is for the ap- 
petite, eliminative powers or nutritive functions of the same 
persons. And the science of eugenics can never be worthy 
of medical consideration until the people are taught that 
it is as much the duty and ousiness of physicians to in- 
quire about the sexual habits of patients as of their habits 
of eating and drinking. This book will do much good, and 
that good will be as extensive as its reading. 

— Texas State Journal of Medicine. 



SEXUAL IMPOTENCE 

in this book we have a complete treatise on sexual dis- 
orders and their treatment, with descriptions of actual 
individual ca°es, giving the individual symptomatology and 
individual treatment. When given in this manner the de- 
scription becomes indelibly impressed on the memory and 
enables a physician when he gets a case to understand and 
classify it without a great amount of difficulty. 

—Charlotte Medical Journal. 

The name of the author is ample assurance that this 
treatise is not a rehash nor lacking in honest opinions fear- 
lessly expressed. The style of the writer is notably per- 
sonal, clear, straightforward and conversational. The ex- 
haustion of the first edition in less than two months from 
the day of publication shows unmistakably the need of 
a book of this character. It also shows that the profession 
is at last becoming alive to its shortcomings in the matter 
of sexual disorders and is beginning to be willing to learn. 
— Southern California Practitioner. 

Perhaps no subject pertaining to human ills has been so 
neglected by medical teachers or medical text-books as 
the subject discussed in this volume. While legitimate 
medical literature was indiscreetly silent on sex teachings, 
the quack literature was teeming with misinformation, 
which, as the author intimates, did more real harm than 
did sexual ignorance or sex abuse. The doctor will find 
this work instructive. — Illinois Medical Journal. 

As is to be expected Robinson goes into the subject 
thoroly, and calls a spade a spade, with the result that he 
has evolved a volume full of meat and of great value to 
the physician, whose ingenuity is often taxed to the ut- 
most to discover the whys and wherefores at the bottom of 
impotence. The racy Robinsonesque style adds interest to 
the text matter of the volume. — Medical Times. 



At last we have a clear, plain, concise book on the treat- 
ment of Gonorrhea and its various complications, written 
expressly for the general practitioner. 

No Physician who has occasion to treat Gonorrhea can do justice to his 
Patient without a study of this latest and clearest volume on the subject. 

THE TREATMENT OF 

GONORRHEA 

And Its Complications in Men and Women. 

For the General Practitioner. 

By 

WILLIAM J. ROBINSON, 

M.D. 

An idea of the scope of this work may be gained from the Chapter Headings, 
i. Extent and Seriousness of Gonorrhea. 2. Classification of Urethra* 
Inflammations. 3. Gonorrheal Urethritis in the Male. 4. The Germ and the 
Diagnosis of Gonorrhea. 5. Course and Symptomatology of Acute Gonorrhea. 
6. Treatment of Acute Gonorrhea. 7. Case Reports. 8. Common Bacterial Ure- 
thritis. 9. Chancroidal Urethritis. 10. Syphilitic Urethritis. n. Chemical 
Urethritis. 12. Prophylactic Urethritis. 13. Traumatic Urethritis. 14. Toxic 
Urethritis. 15. Urethritis from Excess and Masturbation. 16. The Widely Vary- 
ing Conditions Known as Chronic Gonorrhea. 17. Treatment of Chronic Gonor- 
rhea. 18. Length of Time Required to Cure Chronic Gonorrheal Conditions. 19. 
Instruments Used in Treatment. 20. Abortive Treatment. 21. Prevention of 
Gonorrhea. 22. Minor Complications of Gonorrhea (Phimosis, Paraphimosis, 
Balanitis, Adenitis, Painful Erections and Chordee, Retention of Urine). 23. Acute 
Prostatitis. 24. Chronic Prostatitis. 25. Epididymitis. 26. Seminal Vesiculitis. 
27. Gonorrhea of the Rectum. 28. Gonorrhea of the Mouth. 29. Stricture. 
30. Gonorrheal Rheumatism. 31. Gonorrhea vs. Tobacco, Alcohol and Sexual 
Intercourse. 32. Gonorrhea in Women. 33. Vulvovaginitis in Little Girls. 34. 
Gonorrheal Ophthalmia. 35. Minor Points. Part II. — Materia Medica of Gonor- 
rheal and Non-Gonorrheal Urethritis and Their Complications. 36. Silver Salts 
— Inorcranic and Organic. 37. Miscellaneous Antiseptics and Astringents. 38. 
Vegetable Astringents. 39. Local Anesthetics. 40. Anti-Gonorrheal Remediei 
for Internal Use. 41. Urinary Antiseptics. 42. Lubricants. 43. Formulary. 

315 pages, cloth, $3.00 postpaid 
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U MT. MORRIS PARK W NEW YORK CITY 



Population and Birth Control 

A SYMPOSIUM 

EDITED BY 

EDEN and CEDAR PAUL 

One of the greatest books on Birth-Con trol in 
the English or any other language* By writers 
of international reputation. 

CONTENTS 

Introduction, by William J. Robinson; Malthus, a Biographical 
and Critical Study, by Achille Loria; Birth-Control and the Wage 
Earners, by Charles V. Drysdale; Race Suicide in the United 
States, by Ludwig Quessel; Eugenics, Birth-Control, and Social- 
ism, by Eden Paul; Economics of the Birth Strike, by Ludwig 
Quessel; Decline in the Birth-Rate, Nationality, and Civilisation, 
by Edward Bernstein; Philosophy of the Birth Strike, by Ludwig 
Quessel; Over-Population as a Cause of War, by B. Dunlop; The 
Decline in the Birth-Rate, by R. Manschke; Dysgenic Tendencies 
of Birth-Control and of the Feminist Movement, by S. H. Half ord ; 
Women and Birth-Control, by F. W. Stella Browne; Editorial Sum- 
mary and Conclusion. 

Price $3.00 

SMALL OR LARGE FAMILIES 

BIRTH-CONTROL FROM THE MORAL, 
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DR. HAVELOCK ELLIS 

DR. WILLIAM J. ROBINSON 

PROFESSOR A. GROTJAHN 

Price $1.00 

S - ADDRESS ' -■■ ' = 

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IN PRESS 



Sexual Truths 

VERSUS 
SEXUAL LIES, MISCONCEPTIONS 
AND EXAGGERATIONS! 



Edited By 
WILLIAM J, ROBINSON, M.D. 



This book effectually demolishes the 
numerous lies and senseless exaggera- 
tions which dabblers in sexology, either 
through ignorance or design, are offering 
to the public, and which are responsible 
for so much physical misery and mental 
agony. Clear, concise and incisive. 

A necessary book. Send for it 
Price $3.00 

THE CRITIC AND GUIDE CO. 

12 MT. MORRIS PARK W. NEW YORK CITY 



THE AMERICAN JOURNAL 

====== OF ================ 

UROLOGY AND SEXOLOGY 



WILLIAM J. ROBINSON, M.D., Editor 

The only journal in the English lan- 
guage devoted to Sexology. Discusses 
Human Sexuality in all its phases: 
sexual ethics, sexual psychology, the 
anatomy, physiology and pathology of 
the sex organs, venereal prophylaxis, 
limitation of offspring, positive and 
negative eugenics, etc. Publishes the 
best work from the pens of the foremost 
American and European sexologists. 

Nobody earnestly interested in the new 
Science of Sex can afford to be without 
this journal. 

Published Monthly 



Price $5.00 per annum; single copies, 50 cents. 

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THE AMERICAN JOURNAL OF SEXOLOGY 

12 MT. MORRIS PARK W. NEW YORK CITY 



SEX MORALITY 

PAST, PRESENT AND FUTURE 

Will monogamy or variety prevail 
in the future ? 

Is continence injurious ? 

Are extra - marital relations ever 
justifiable ? 

Should there be one moral stand- 
ard for men and women ? 

Will our present moral code persist? 

These and similar questions are here discussed 
by original and unbiased thinkers as well as by 
orthodox conservatives. No matter what your 
opinion on the subject may be, no matter whether 
your ideas on the relations of the sexes are those 
of the 1 5th, 20th or 25th century, you should 
read this book. Nobody who is earnestly inter- 
ested in the sex question has a right to have any 
opinion on it without having read this volume, the 
price of which, in cloth, is $ I , including postage. 

THE CRITIC AND GUIDE CO. 

12 MT. MORRIS PARK W. NEW YORK CITY 



A UNIQUE JOURNAL 
THE 

CRITIC and GUIDE 

Dr. Robinson's Famous Little Monthly 



It is the most original journal in the country. It is the only- 
one of its kind, and is interesting from cover to cover. There is no 
routine, dead matter in it. It is one of the very few journals 
that is opened with anticipation just as soon as it is received and 
of which every line is read with real interest. 

Not only are the special problems of the medical profession itself 
dealt with in a vigorous and progressive spirit, but the larger, social 
aspects of medicine and physiology are discussed in a fearless and 
radical manner. 

Many problems untouched by other publications, such as the sex 
question in all its varied phases, the economic causes of disease and 
other problems in medical sociology, are treated boldly and freely 
from the standpoint of modern science. In discussing questions 
which are considered taboo by the hyper-conservative, the editor 
says what he wants to say very plainly without regard for Mrs. 
Grundy. 

The Critic and Guide was a pioneer in the propaganda for 
birth control, venereal prophylaxis, sex education of the young, and 
free discussion of sexual problems in general. It contains more 
interesting and outspoken matter on these subjects than any other 
journal. 

While of great value to the practitioner for therapeutic sugges- 
tions of a practical, up-to-date and definite character, its editorials 
and special articles are what make The Critic and Guide unique 
among journals, read eagerly alike by the medical profession and 
the intelligent laity. 



PUBLISHED MONTHLY 
TWO DOLLARS A YEAR 



CRITIC AND GUIDE CO. 

12 MT. MORRIS PARK W. NEW YORK CITY 



A LIST OF OUR 
PUBLICATIONS 



Treatment of Sexual Impo- 
tence $4-oo 

Treatment of Gonorrhea. . . 3.00 
Woman: Her Sex and 

Love Life 3- 00 

Sexual Problems of To-day 2.00 
Sex Knowledge for Men 

and Boys 2.00 

The Limitation of Off- 
spring by the Prevention 

of Conception 1.50 

Small or Large Families. 
By Drysdale and Have- 
lock Ellis 1.00 

Never Told Tales 1.00 

Stories of Love and Life. . . 1.00 
Eugenics and Marriage ... 1.00 
Sex Knowledge for Wom- 
en and Girls 1.00 

Sexual Truths 3.00 

Prescription Incompatibili- 
ties 3.00 

Sex Morality — Past, Pres- 
ent and Future 1.00 

The Sexual Crisis. Meisel- 

Hess 

Population and Birth 

Control. A symposium . 

The Critic and Guide, 

Monthly, single copies 25 

cts.; a year 2.00 

The American Journal of 
Urology and Sexology, 
Monthly, single copies 50 
cts. ; a year 5.00 



3.00 



3.00 



Dr. Jacobi's Collected 

Works, 8 vols $15.00 

Uncontrolled Breeding, or 
Fecundity vs. Civiliza- 
tion. Adeline More .. . 1.00 

The Prevention of Sexual 
Diseases, by Victor G. 
Vecki, M.D 1.50 

Sex Morality and Ner- 
vousness, by Prof. 
Freud 



The Venereal Peril, by 
Wm. L. Holt, M.D 

The Social Evil, by Wm. 
L.Holt, M.D 

The Ten Greatest Hu- 
manitarians, A sympo- 
sium conducted by Dr. 
Victor Robinson 

The Hunter, by Olive 
Schreiner, with an in- 
troduction by Dr. Rob- 
inson, entitled, A Page 
from My Life, paper 25c. 

Scientific Medicine vs. 
Quackery 

Pathfinders in Medicine. 
Dr. Victor Robinson . . . 

Constipation in Adults and 
Children. H. Illoway, 
M. D. (reduced from 
$5-oo) 



.25 



•25 



.25 



•50 



.10 



2.50 



3-oo 



Books not otherwise marked are by Dr. Wm. J. Robinson 



THE CRITIC AND GUIDE CO. 

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LIBRARY OF CONGRESS 



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